How Many Types of Acne Are There, and How Does Treatment Differ?

How many types of acne are there? Dermatologists generally divide acne into 2 main groups: non-inflammatory acne, namely whitehead and blackhead comedones, and inflammatory acne, namely red papules, pustules, nodules/lumps, and cysts. There are also conditions that resemble acne, such as hormonal acne, heat-related acne, and fungal acne, which work through different mechanisms and call for different care.

Understanding which type your acne falls into helps you choose more targeted care, because each type has different causes and responds differently to treatment. This article was prepared by the editorial team and reviewed for content by an experienced doctor at Onnyx Clinic, to provide information that is easy to understand and grounded in medical sources.

What Causes Acne

Acne arises from abnormalities of the hair follicles and oil glands, with several main contributing factors working at the same time, which clogs the pores and sometimes leads to inflammation.

Factors involved in the formation of acne include:

• Increased oil (sebum) production, which is often stimulated by androgen-group hormones
• Abnormal shedding of skin cells inside the pore, which causes skin cells to build up and clog the pore
• The bacteria Cutibacterium acnes (formerly called Propionibacterium acnes), which live in the pore; as oil builds up, they multiply and trigger inflammation
• The body’s inflammatory process, which responds to the clogging and the bacteria

Certain external factors and behaviors may contribute to worsening acne, such as stress, inadequate rest, the use of cosmetics or products that clog the pores, and hormonal changes. That said, certain foods remain a topic that requires further study, so this should be considered on an individual basis. Acne is a common condition and is normal across many stages of life, especially in teenagers whose hormones are changing, but it is also seen in adults. Understanding this underlying cause helps make it clear why each type of acne needs different care.

How Many Types of Acne Are There

Dermatologists usually divide acne (acne vulgaris) into 2 major groups based on whether inflammation is present, which is an important foundation for choosing a care approach.

Group 1: Non-inflammatory acne (comedonal acne) arises from pores clogged with oil and skin cells, without clear inflammation yet. It is subdivided into:

• Closed comedones (whiteheads) are small white or flesh-colored bumps beneath the skin because the pore is closed
• Open comedones (blackheads) have a head exposed to air, so it undergoes oxidation and turns black, not dirt as many people assume

Group 2: Inflammatory acne occurs when bacteria and inflammation are also involved, and often develops from comedonal acne. It is subdivided into:

• Papules are small raised red bumps that are tender when pressed and have no pus yet
• Pustules are red bumps with a white or yellow pus head in the center
• Nodules / lumps are large, firm lumps beneath the skin, tender when pressed, sitting deeper than ordinary bumps
• Cysts are soft lumps containing fluid or pus deep down; when found together with nodules, this is often called nodulocystic acne, a type that carries a high risk of scarring

The severity of acne is usually assessed from the type and number of lesions, ranging from mild (mainly comedones) to severe (with nodules and cysts), and this severity level affects the choice of care approach.

How Hormonal Acne Differs From Ordinary Acne

Hormonal acne is acne linked to hormonal changes, especially the androgen group, which stimulates the oil glands to produce more oil. The signs that set it apart from ordinary acne are its location and timing.

According to the American Academy of Dermatology (AAD), hormonal acne in adults tends to appear on the lower part of the face, namely the jawline, chin, and lower cheeks, unlike teenage acne, which often spreads across the forehead and nose (the T-zone). In addition, hormonal acne in many women is also linked to the menstrual cycle, often flaring up in the days before menstruation and easing once menstruation begins.

Other features commonly seen with hormonal acne:

• Tends to be deep inflammatory acne, such as red papules or nodules, rather than ordinary comedones
• Found in adult women who may never have had severe acne as teenagers
• In some cases may be linked to conditions involving high androgen levels, such as polycystic ovary syndrome (PCOS), which should be assessed by a doctor

That said, many women with hormonal acne have normal hormone levels but may have skin that is more sensitive to normal levels of hormones than other people. Diagnosis therefore relies on clinical features together with history, and in some cases may require further testing. Care for hormonal acne is often different from ordinary acne, because it may require considering hormone-related approaches under a doctor’s supervision. So if you suspect hormonal acne, consulting a doctor helps you obtain an approach suited to each individual.

Heat-Related Acne vs. Comedonal Acne vs. Fungal Acne: How to Tell Them Apart

These three conditions are often confusing because they look alike, but their mechanisms differ and, importantly, their care differs too. Telling them apart correctly therefore helps reduce care that misses the mark.

• Comedonal acne consists of small bumps that arise from pores clogged with oil and skin cells, coming as both whiteheads and blackheads, usually not itchy, and responding to the group of medications that help exfoliate skin cells
• Heat-related acne usually refers to many small bumps that appear quickly, often linked to heat, sweat, irritation, or products unsuitable for the skin; sometimes it is irritation of the pores rather than true comedonal acne
• Fungal acne (Malassezia / Pityrosporum folliculitis) arises from the Malassezia yeast that lives naturally on the skin multiplying inside the hair follicles. The signs are that the bumps are usually of similar size, arranged along the hair follicles, come with itching, and often have no clogged comedone head

A point to watch closely is that fungal acne is often mistaken for ordinary acne. According to a report in the AAD’s journal, the antibiotics used to treat inflammatory acne may not work on fungal acne and can sometimes make symptoms worse, whereas antifungal medications may help. Note also that ordinary acne and fungal acne can occur together, so telling them apart by eye is not always accurate. If initial care does not improve things or there is prominent itching, you should consult a doctor for a correct diagnosis, because care that matches the cause naturally gives a more suitable result, with results varying by individual.

How Care/Treatment Differs for Each Type

The key principle is that different types of acne require different approaches. Care suited to comedonal acne may not cover severe inflammatory acne. The table below summarizes the overall picture so you can see the differences; it is general information and not an individual diagnosis.

Care approaches according to general principles include:

• Comedonal acne usually starts with basic care, such as gentle skin cleansing, choosing products labeled as non-comedogenic, and possibly using exfoliating groups under guidance. According to AAD information, topical retinoids often work well for comedonal acne
• Mild to moderate inflammatory acne may require products with antibacterial and anti-inflammatory action as well, which should be under a doctor’s supervision
• Nodules, cysts, or severe acne should see a doctor early on, because of the risk of scarring and pitted scars. Assessment by a doctor helps plan care suited to the severity

Acne is a chronic condition that often requires time and consistency. Care results vary by individual, by the type and severity of acne, and by individual-specific factors. If you are looking for an approach assessed according to your own skin condition, you can see Onnyx Clinic’s acne care program to consult an experienced doctor.

When to See a Doctor

You should consult a dermatologist when acne starts to affect your quality of life or risks scarring. Seeing a doctor early helps you get a correct diagnosis and plan care appropriately.

Signs that you should see a doctor include:

• Severe inflammatory acne, with nodules or cysts that are tender when pressed and sit deep
• Persistent acne that does not improve within a reasonable time despite initial self-care
• Acne that leaves dark marks or begins to produce pitted scars and scarring
• Acne suspected to be hormone-related, such as appearing along the jawline and linked to the menstrual cycle, or with other accompanying symptoms
• Acne that affects confidence and mental well-being

The doctor will take a history, examine the appearance of the acne, and assess severity, in order to distinguish the type of acne from conditions that resemble acne, and then recommend a care approach suited to each individual. Getting advice from a doctor also helps reduce the risk of trying many products on your own, which sometimes makes the skin more irritated.

A Thing to Avoid: Squeezing or Popping Acne Yourself

Popping or squeezing acne yourself is not recommended, because it is a behavior that raises the risk of follow-on problems more than it helps acne clear faster.

Reasons to avoid it:

• Squeezing can push inflammation and bacteria deeper, making acne more inflamed
• It raises the risk of infection from unclean hands and nails
• It causes post-inflammatory hyperpigmentation (PIH) and risks pitted scars that are hard to fix later

If you have a comedone that needs to be extracted, it should be done by a medical professional in a clean environment with appropriate tools. You should also avoid harsh scrubbing, using many products at once without consulting a doctor, and frequently touching your face. Choosing a clinic that meets standards and has doctor supervision also plays an important part in safety.

If you are dealing with acne and want advice assessed according to your own skin condition, you can consult Onnyx Clinic’s experienced medical team via LINE: @onnyxclinic to ask questions and plan care suited to you. Care results vary by individual.

References

• American Academy of Dermatology — Acne: Overview & Types: https://www.aad.org/public/diseases/acne
• Journal of the American Academy of Dermatology — Guidelines of care for the management of acne vulgaris: https://www.jaad.org/article/S0190-9622(23)03389-3/fulltext
• Cleveland Clinic — Fungal Acne (Malassezia/Pityrosporum Folliculitis): https://my.clevelandclinic.org/health/diseases/24341-fungal-acne
• National Library of Medicine (PMC) — Malassezia (Pityrosporum) Folliculitis Masquerading As Recalcitrant Acne: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996476/
• Journal of the Endocrine Society — Female Adult Acne and Androgen Excess: https://academic.oup.com/jes/article/6/3/bvac003/6523224