The makings of a zit are threefold: dead skin, sebum and bacteria. But this cocktail of mayhem takes a specific mixing to wreak havoc on your skin. It’s normal for dead skin cells to collect in pores then rise to the surface of the opening and (ideally) fall away. It’s also normal for your skin to produce sebum, a natural oil that helps prevent it from drying out, from glands attached to pores. And it’s normal for propionibacterium acne bacteria to be present on the skin. It loves it there.
But when excess sebum builds up, causing dead cells to stick together and trap bacteria, it forms a mixture in the pores, and voila! Now you have non-inflammatory acne. Cue inflammation and you have worse, often times more painful acne. Sebum acts like fuel to inflammation, creating a hard-to-break cycle.
The severity of acne and your treatment options depend on whether it’s inflammatory or non-inflammatory. (1, 2, 3)
Comedones, or whiteheads and blackheads, are the most common type of acne and they’re non-inflammatory. They’re plugged pores, yes, but they’re not yet inflamed. However, that can quickly change if you start prodding and pocking at them thinking you’re doing your skin a solid when you’re actually just pushing the oil, bacteria and dead cells deeper into the pore. (4, 5)
If skin over the plugged pore remains intact, you’ll see a tiny, closed white or skin-colored bump. That’s a whitehead. Go figure. If the plugged pore you’re looking at is darker in color, it’s a blackhead. Blackheads form when the skin over the comedone opens up, exposing the melanin in the sebum to the air, causing it to oxidize and darken. (6, 7)
Patience, good skincare habits and absolutely no sharing your makeup brushes with anyone, not even your sister who basically has the same genetic makeup as you. Maybe not the miracle solution you were hoping for, but a gentle cleanser and exfoliator are still the best tools in your arsenal to keep your skin clear of comedones. If that’s not cutting it, turn to topical retinoids or salicylic acid.
Over time, retinoids increase cell turnover which helps unblock pores by removing dead skin cells that contribute to the formation of acne. Careful what you reach for though. Topical retinoids can be harsh on more sensitive skin, leading to irritation.
The wunderkind of the acne-fighting world, this beta hydroxy acid also dislodges dead skin cells that are clogging pores. Salicylic acid works by breaking apart the attachments keeping dead skin cells hanging on and penetrates deeper, triggering exfoliation from the outside in. Fair warning: Just because it’s derived from plants like willow bark, wintergreen leaves and sweet birch doesn’t mean it operates with the gentlest hand. A 2% concentration of salicylic is high and might be drying or irritating with overuse. (8, 9)
When a pore clogs and bacteria multiplies in the pore, your immune system has thoughts, feeling, and reactions — namely, sending out the troops in the form of white blood cells to the front lines. That’s when the surrounding area becomes red, swollen and inflamed. Inflamed acne might require a combination of at-home care and in-office treatment, depending on its severity. So let’s suss out what we’re dealing with here, exactly. (10)
More commonly known as pimples, pustules look like whiteheads but filled with more than the usual cocktail of sebum and dead cells. When immune cells and bacteria cells collect, they form pus, giving pimples their white-to-yellow color and squeeze-me-if-you-dare appearance. Papules, on the other hand, are hard, generally concentrated bumps that form when whiteheads or blackheads cause so much irritation that they damage the surrounding skin, leading to inflammation. Popping can exacerbate the damage because it pushes the oil, dead skin and bacteria deeper into the pore. Talk about self-sabotage. (11)
Return to our reliable salicylic acid, to help unclog pores and speed up recovery. But you might need to pair it with something a little stronger to kill acne-causing bacteria, too.
Benzoyl peroxide sounds...scary. And it’s certainly a powerful enough ingredient to warrant caution, but it’s also hella effective because it actually kills the bacteria responsible for acne’s onset. Using it sparingly in conjunction with salicylic acid, but not at the same time, gives you a multi-pronged approach to fighting acne on both major causation fronts: dead skin and bacteria. If you’re nervous about how much to use and how often, check in with your derm. (12)
This is when s*** gets serious. And painful. Nodules are hard, inflamed lumps that develop when clogged pores cause damage to tissue and cells deep beneath the skin’s surface. They look like larger, deeper papules but with no visible center or head. Cystic acne is the most severe type of acne that forms even deeper than nodules. Clogged pores become ruptured and blocked, leading not only to inflammation but possibly infection. Both nodules and cysts can lead to acne scarring, which is difficult to treat after the fact.
If you’ve given at-home treatments like salicylic acid and benzoyl peroxide time to work, say 6-8 weeks, and you’re not seeing any improvement it might be time to call in the professionals. Large lesions like nodules and cysts are painful and typically need to be treated by a dermatologist who can prescribe drug treatments like isotretinoin as well as walk you through potential side effects and proper usage. (13, 14, 15)
