Acne – mild to severe, and everything in between

It is safe to say that at some stage of their lives, acne is a reality to most people. It’s just quite simply part of being human, but that is difficult to remember or accept when a nasty pimple appears on your chin the day before your wedding, or your Matric dance.

Even models, or people who appear to have flawless skin, will, on closer inspection prove to have at least a few blackheads or pimples. They possibly have just learnt to hide them well.

All forms of acne start in the same way: oil (sebum) or dead skin cells clog (or partially clog) up a skin pore or a hair follicle. Each follicle contains one hair and a so-called sebaceous glands that produce oil. Excess oil production can be the result of hormonal fluctuations, or another substance, such as makeup or dirt, could block up the pore.

Some medical conditions, such as Polycystic Ovarian Syndrome, or rosacea (a skin condition that causes redness and sometimes small pimples), can cause acne or skin blemishes or discolouration. If your acne suddenly gets worse, it is recommended that you see your doctor, who could refer you to a dermatologist (skin specialist) if he/she thinks it is necessary. If your problem is hormonal, you may have to see a gynaecologist, who could send you for tests to check your hormone levels.

One of the reasons acne can cause distress, is because it often manifests on the face, where it cannot be concealed as easily, as it would be on, say, the upper arm or the chest. For most adolescents, their appearance is very important, and ongoing acne can become problematic.

Acne treatments range from over-the-counter remedies, to regular skin-cleansing rituals, to hormonal treatments to prescription medication from a dermatologist, depending on the severity of the condition.

Acne is the general term that is used to describe blackheads, whiteheads, pimples, papules (small, red and tender bumps), nodules (larger, more painful bumps) and cystic lesions (painful pus-filled lumps which are under the skin). These are almost always the result of hair follicles becoming clogged. Sometimes the effect is little more than a passing irritation, and other times it can be painful and cause physical and emotional distress, such as when bacteria finds its way into the blocked follicle or pore, and causes inflammation. This clogged up pore/follicle is called a comedo and it lies at the centre of all the different types of acne.

Here’s more about each of these.


These are often found on the face, but can also appear on the back, the neck, the arms, shoulders and chest. Dead skin cells and oil form a plug in the opening of the hair follicles, but do not close it completely. The pore remains open, and the exposure to the air causes the little plug to turn dark. Blackheads are not inflamed, and are therefore not painful. They can be pushed out, but it is wise to get advice from a pharmacist or a skincare professional. Most treatments for blackheads are aimed at reducing oil production in the skin, unclogging the pores, and helping your body to make new skin cells.


This form of acne is more visible than blackheads and form when a clogged pore becomes inflamed or infected with bacteria. These are smaller than normal pimples, but still easily visible. The closed comedo can form a red, painful bump, and become pus-filled. They can be found on the same body parts as blackheads because those are where the skin has the largest number of sebaceous glands. Many people are tempted to squeeze whiteheads, but this is not recommended as it can make things worse if the surrounding skin becomes inflamed. Whiteheads will open and clear by themselves if simply left to their own devices.

Pimples, papules

These are larger (less than 1cm) than blackheads or whiteheads and form when pressure in the clogged pore builds up, and ruptures its sides, causing bacteria to seep into the surrounding skin. This can cause inflammation and skin that is red and painful to the touch. Papules are also called skin lesions. A lesion refers to a change in skin colour and texture. Many diseases, such as eczema and chickenpox can cause papules on the skin. Sometimes a papule will progress into a pustule or pimple when a white head forms on the blemish. Often, pustules will just go away by themselves. Speak to a doctor if the condition becomes widespread. Touching or squeezing pimples or papules can increase the inflammation to the surrounding skin and could possibly cause scarring.


Nodules are larger than pustules (about 2cm) and are more solid lesions that lie deep within in the skin. They can be very painful and feel hard to the touch. These start off in the same way as blackheads and whiteheads and pustules, but the pore becomes completely clogged and infected with bacteria that goes deep into the skin. It doesn’t form a head like pimples and whiteheads do. They can persist for weeks, and sometimes even months, and their contents can harden deep under the skin. They are more difficult to treat than the types of acne mentioned above. Topical agents can sometimes be used to dry out the lesions, and sometimes a doctor will prescribe antibiotics. A visit to a dermatologist is recommended if you have persistent nodules.

Cystic lesions

This is the most serious type of acne, which forms deep under the skin. This form of acne is relatively rare. It starts off in the same way as other types of acne – with excess oil production and clogged pores. But these then become inflamed and infected and produce painful cysts and nodules alongside ordinary pustules. The sides of the pore rupture, and the inflammation spreads deep into the skin. The risk of scarring is high. There seems to be a genetic link in the development of cystic acne. Even when cystic lesions clear up, they sometimes leave pink discolouration on the skin. Cystic lesions cannot be treated with home remedies, and it would be wise to consult a dermatologist.

(Sources: National Health Systems (UK),, News Medical Life Sciences,,

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