# Types of acne explained: blackheads, whiteheads, papules, pustules, nodules and cysts URL: https://dermalguide.com/articles/acne-types-explained/ Part of: https://dermalguide.com/acne/ Published: 2026-10-18 ยท Updated: 2026-10-22 > What each acne spot type is, how comedonal, inflammatory, cystic and hormonal acne differ, and which types you can treat at home versus with a dermatologist. ## Short answer Acne comes in two broad groups. Non-inflammatory acne is blackheads (open comedones) and whiteheads (closed comedones): clogged pores without redness. Inflammatory acne is papules, pustules, nodules and cysts: red, swollen spots, with nodules and cysts sitting deep in the skin and most likely to scar. "Hormonal acne" isn't a separate spot type; it describes a pattern, often tender spots along the jawline and chin. ## What this means for you ### Start with what you notice Name the spot you are looking at, because what you can treat at home depends on the type. ### The ingredient names, translated Acne spots range from small clogged pores (blackheads and whiteheads) to red pimples and deep, painful lumps (nodules and cysts). The small, non-red kinds usually respond to over-the-counter products. Deep, painful lumps need a doctor because they can leave permanent scars. ### How to decide - A dark plug or a pale tip with no redness is a comedone: a clogged pore. - A red or swollen spot is an inflammatory pimple. Pus-filled means it is already opening. - A bump you feel as a hard lump under the skin, with no head, is a nodule or cyst. Those are the ones that can leave permanent marks. - A pattern along the jaw and chin describes where acne appears, not a separate spot type. ### What to expect Clogged pores and surface pimples usually respond to over-the-counter treatment within six to eight weeks. Deep lumps may still leave a change in skin texture afterwards, which is why a dermatologist is worth asking about for those. General guidance, not a test of these products: [How to treat different types of acne (American Academy of Dermatology)](https://www.aad.org/public/diseases/acne/diy/types-breakouts); [Acne: overview (NHS)](https://www.nhs.uk/conditions/acne/); [Comedonal acne (DermNet)](https://dermnetnz.org/topics/comedonal-acne); [Guidelines of care for the management of acne vulgaris (J Am Acad Dermatol, 2024)](https://doi.org/10.1016/j.jaad.2023.12.017); [Stubborn acne? Hormonal therapy may help (American Academy of Dermatology)](https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy); [Adult acne (American Academy of Dermatology)](https://www.aad.org/public/diseases/acne/really-acne/adult-acne). Each product's label source is linked on its product page. Knowing which type you have matters because, as the [American Academy of Dermatology (AAD)](https://www.aad.org/public/diseases/acne/diy/types-breakouts) puts it, each type needs different treatment. Most people have a mix. ## What are the different types of acne spots? | Type | What it looks like | Inflamed? | Scar risk | Where to start | |------|--------------------|-----------|-----------|----------------| | **Blackhead** (open comedone) | Small dark dot in an open pore, flat or slightly raised | No | Low | OTC retinoid (adapalene) or salicylic acid | | **Whitehead** (closed comedone) | Small white or skin-coloured bump; nothing comes out when pressed | No | Low | OTC retinoid (adapalene) | | **Papule** | Small, hard, red bump with no visible head | Yes | Moderate if picked | Benzoyl peroxide or salicylic acid wash | | **Pustule** | Red bump with a white or yellow centre | Yes | Moderate if picked | Benzoyl peroxide or salicylic acid wash | | **Nodule** | Large, hard, painful lump deep under the skin | Yes | High | Dermatologist | | **Cyst** | Large, soft, pus-filled lump, like a boil | Yes | Highest | Dermatologist | Sources: [AAD](https://www.aad.org/public/diseases/acne/diy/types-breakouts), [NHS](https://www.nhs.uk/conditions/acne/). ### Blackheads (open comedones) A blackhead is a pore plugged with oil and dead skin cells that stays open at the surface. The [NHS](https://www.nhs.uk/conditions/acne/) notes they're not filled with dirt: the colour comes from pigment produced by the lining of the hair follicle. [DermNet](https://dermnetnz.org/topics/comedonal-acne) says the same (surface pigment, melanin). The AAD warns that scrubbing them will only make acne worse. Many "blackheads" on the nose are actually sebaceous filaments, a normal part of every pore. See [blackheads vs sebaceous filaments](https://dermalguide.com/articles/blackheads-vs-sebaceous-filaments/) for how to tell them apart. ### Whiteheads (closed comedones) A whitehead is the same kind of plug, but the pore has closed over it, so you see a small white or skin-coloured bump. The NHS describes them as firmer than blackheads and notes they won't empty when squeezed. DermNet says comedonal acne (mostly blackheads and whiteheads) most often affects the **forehead and chin**. If you have lots of small, uniform bumps on your forehead, they might be closed comedones, but they could also be fungal acne or keratosis pilaris. Our guide to [forehead bumps](https://dermalguide.com/articles/forehead-bumps-comedones-fungal-acne-or-kp/) compares the three. ### Papules (early pimples) When oil, bacteria and dead skin push deeper and cause inflammation, you get small, red, hard bumps with no visible head. The AAD notes that lots of papules together can make the skin feel like sandpaper. ### Pustules (pus-filled pimples) Pustules are like papules but contain yellowish fluid, so you see a white or yellow centre. These are what most people call "pimples" or "zits". The AAD advises against popping them because it can make acne worse. ### Nodules Nodules are large, hard, often painful lumps that form beneath the surface of the skin (NHS). They don't come to a head, and squeezing them doesn't empty them. ### Cysts Cysts are the most severe acne spot: large, pus-filled lumps that look like boils and carry the greatest risk of permanent scarring (NHS). The AAD notes that the sooner nodules and cysts are treated, the fewer permanent scars you'll have. > **Skin Realist check:** "cystic acne" is often used loosely online for any big, sore pimple. If a spot is deep, painful and lasts for weeks, treat it as a nodule or cyst and see a doctor, whatever you call it. Don't try to pop it. ## What's the difference between comedonal, inflammatory and cystic acne? These terms describe the **overall pattern**, based on which spots dominate: - **Comedonal acne:** mostly blackheads and whiteheads, with little redness. DermNet notes treatment often has to continue long-term, sometimes for years, because new comedones keep forming. - **Inflammatory (papulopustular) acne:** mostly red papules and pustules, usually with some comedones too. - **Nodular or nodulocystic acne:** nodules and/or cysts. This is severe acne and needs a dermatologist. Doctors also grade acne as **mild, moderate or severe** based on how many spots there are and how deep they go. The NHS advises seeing a GP if acne is moderate or severe, or if you develop nodules or cysts. ## What is hormonal acne? "Hormonal acne" is a pattern, not a spot type. The [AAD](https://www.aad.org/public/diseases/acne/derm-treat/hormonal-therapy) describes it in women as acne that keeps appearing on the **lower face, jawline and neck** despite other treatments. The spots are often deep and tender. Some useful facts: - **Hormones play a role in all acne.** The AAD lists fluctuating hormones around periods, during pregnancy, perimenopause and menopause, and after starting or stopping birth control pills as common triggers of [adult acne](https://www.aad.org/public/diseases/acne/really-acne/adult-acne). Stress is another: the body produces more androgens in response to it. - **Adults do get acne.** The AAD notes that some adults keep getting acne into their 30s, 40s and 50s, and some get it for the first time as adults. The NHS says about 3% of adults over 35 have acne. - **Treatment is by prescription.** The two hormonal treatments the AAD describes for women are birth control pills and spironolactone. On average, women notice improvement on the pill after 2 to 3 months. Spironolactone isn't prescribed to men for acne because of side effects, and it requires reliable contraception. These are decisions to make with your doctor; there's no over-the-counter hormonal acne product. If you also have irregular periods, extra facial or body hair, or hair thinning on your scalp, mention it to your doctor. The AAD notes acne can sometimes be a sign of an undiagnosed medical condition. ## Where on the body does acne appear? The NHS says acne affects the face in almost everyone who has it, the back in more than half, and the chest in about 15%. Body acne is covered in [body acne on the back and chest](https://dermalguide.com/articles/body-acne-back-chest/). ## Which types of acne can you treat at home? The 2024 [American Academy of Dermatology guidelines](https://doi.org/10.1016/j.jaad.2023.12.017) give their strongest recommendations to **benzoyl peroxide** and **topical retinoids**, among others. **Salicylic acid** and **[azelaic acid](https://dermalguide.com/ingredients/azelaic-acid/)** get a conditional (weaker) recommendation. In practice: - **Blackheads and whiteheads:** the AAD recommends a retinoid to unclog pores, plus a benzoyl peroxide wash. One retinoid, **adapalene**, is sold without a prescription in the US. See [how to clear blackheads](https://dermalguide.com/articles/how-to-clear-blackheads/). - **Papules and pustules:** the AAD suggests washing twice daily with an acne wash containing **benzoyl peroxide** or [**salicylic acid**](https://dermalguide.com/ingredients/salicylic-acid/). If you have a lot of them, see a dermatologist. - **Nodules and cysts:** these need a dermatologist. Prescription options include oral antibiotics, hormonal therapy and isotretinoin, which the 2024 guidelines strongly recommend for severe acne, acne causing scarring or acne that hasn't responded to other treatment. **Give any treatment six to eight weeks.** That's the AAD's guidance for both comedones and pustules. If you see no improvement by then, a dermatologist can help. > **Skin Realist check:** using more products at once doesn't speed things up. Stacking several acne actives mostly adds irritation. Start with one, and see [OTC acne treatments compared](https://dermalguide.com/articles/otc-acne-treatments-compared/) before adding a second. ## Is it really acne? Several conditions look like acne but need different treatment. Fungal acne (Malassezia folliculitis), keratosis pilaris and rosacea are the common mix-ups. If your bumps itch, are all the same size, or don't respond to acne treatment after a couple of months, read [fungal acne explained](https://dermalguide.com/articles/fungal-acne-malassezia-folliculitis/) or ask a dermatologist. ## When should you see a dermatologist? See a doctor if: - you have nodules or cysts, or any deep, painful spots - acne is leaving scars or dark marks - over-the-counter treatment hasn't helped after six to eight weeks - acne appeared suddenly as an adult, or comes with other symptoms such as irregular periods or excess hair growth - acne is affecting your mood or confidence More on this in [when to see a dermatologist about acne](https://dermalguide.com/articles/acne-when-to-see-a-dermatologist/). ## Frequently asked questions ### What are the main types of acne? There are six main spot types. Blackheads and whiteheads are non-inflammatory (clogged pores). Papules, pustules, nodules and cysts are inflammatory (red and swollen). Most people have more than one type at the same time. ### Is cystic acne the same as nodular acne? They're related but not identical. Both sit deep in the skin and are painful. The NHS describes nodules as large, hard lumps and cysts as large pus-filled lumps that look like boils. Cysts carry the greatest risk of permanent scarring. Both need a doctor. ### Is hormonal acne a type of acne? Not a separate spot type. "Hormonal acne" usually describes a pattern in adult women: deep, tender spots on the lower face, jawline and neck that flare around periods. The spots themselves are papules, pustules or nodules. A dermatologist can prescribe hormonal treatments if they fit. ### Are blackheads dirt? No. The NHS and DermNet both explain that the dark colour comes from pigment in the plug, not dirt. That's why scrubbing harder doesn't help and can make acne worse. ### Which types of acne can I treat at home? Blackheads, whiteheads and a few papules or pustules usually respond to over-the-counter treatments such as adapalene, benzoyl peroxide or salicylic acid. Give them six to eight weeks. Nodules and cysts need a dermatologist. ### When should I see a doctor about acne? The NHS advises seeing a GP for moderate or severe acne, or for nodules or cysts, because they need proper treatment to avoid scarring. Also see a doctor if over-the-counter treatment hasn't helped after six to eight weeks, if acne is affecting your mood, or if it appeared suddenly as an adult. Amazon links on this site are affiliate links. This is general information, not medical advice.