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Decode your acne: The 6 types of spots and how to treat them

From blackheads to cysts, we reveal everything you need to know to decode your spots and share how best to treat them too

While we know that periods of glowing, clear skin are achievable with the help of efficacious skincare and in-clinic treatments, it’s worth remembering that everyone gets breakouts, and they’re nothing to be ashamed of.

Why we get them varies from person to person, they could be thanks to naturally oily skin, hormone imbalances, or stress. And how we get them varies too, as they come in many forms, making it “imperative that you have an understanding of the different types of spots there are, in order for you to treat them accordingly,” explains Être Vous expert and Founder of Miriderma Clinic, Dr Sandra Gamper.

To help decode your breakouts, learn how to treat them, and know when to seek expert advice, read on…


Otherwise known as closed comedones, whiteheads are a common type of spot that are not typically inflamed or painful and can be identified by their white appearance. “Comedones arise when there is an overproduction of sebum, and a build-up of dead skin cells that when combined block the pore,” explains Gamper.

A layer of skin further covers the blockage, resulting in bulging whiteheads, that have to be punctured (which risks trauma and scarring) for the contents to be extracted.

“Topical treatments work well for comedonal acne, but it may take several weeks or months to see long-term improvement, so patience is key,” says Gamper. “Options include skincare that contains benzoyl peroxide, azelaic acid, and salicylic acid. As well as vitamin A derivatives know as retinoids, that are available over-the-counter as retinol, and retinaldehyde or prescription-strength varieties such as adapalene and tretinoin.”


Another form of comedonal acne, blackheads occur under the same circumstances as whiteheads but do not have a layer of skin over the blocked follicle (the canal of the pore).

“There is a common misconception that blackheads are caused by dirt, which is not the case. In fact, blackheads are actually open comedones, containing exactly the same excess oil and dead skin as a closed comedone. But due to their open nature they become exposed to air, which oxidises the contents turning it black,” says Gamper.

In theory, because the pore is ‘open’, blackheads should be easier to squeeze at home. However, their sticky nature creates a plug in the pore that can prove stubborn to budge. “Avoid squeezing blackheads at home as there is a significant risk of causing trauma to the surrounding skin. An experienced practitioner should be able to help with extractions, and regular chemical peels,” recommends Gamper.

What you can do at home is make sure your skincare regime consists of at least one beta-hydroxy acid, as they are oil soluble which means it’s able to penetrate deeply within pores to dissolve excess sebum to keep pores clear. Salicylic acid is an excellent and widely used BHA found in cleansers, toners, serums, moisturisers and spot treatments.


If your spots are small, painful and don’t have a head on them, there is a high chance you’re dealing with a papule.

“These lesions develop when a closed comedone ruptures and disperses the bacteria into the skin tissue — rather than on the skin’s surface. This triggers the immune system to activate an inflammatory response, to fight off the bacteria, resulting in a papule,” explains Gamper.

Attempting to squeeze or extract papules at home is strongly advised against as doing so is likely to lead to scarring and increase the risk of post-inflammatory hyperpigmentation.

Topical, at-home treatment options are similar to those for comedonal acne, but medical treatments can also be administered for severe cases. “You may wish to consider oral antibiotics, combined hormonal contraceptives or spironolactone an anti-androgen medication to help lower sebum production,” says Gamper.


When you think of spots, it’s likely that mental images of pustules come straight to mind. Similar to papules, pustules are raised and inflamed spots that can often be sore and painful.

Unlike papules, however, pustules contain pus (hence the name) and can present with a white head. Often found on the body as well as the face, “pustules can arise due to hormonal imbalances and changes, or as a by-product of an infection in the pore,” explains Gamper.

Acne pustules can become hard and painful and turn into cysts, but it’s wise to not touch them and stick to retinoids, exfoliating acids or prescription medication to treat them as damaging the skin can lead to scarring.


Unlike other forms of acne, nodular acne develops when the bacteria p.acne gets trapped in your pores alongside sebum and dead skin cells. This results in an infection deep within the skin, leading to “painful, hard, solid and raised inflammatory spots that typically measure less than 1cm and look like bumps under the skin. Depending on your skin tone they can turn red on fair and olive skins while on darker skin they either present as the same shade or darker,” shares Gamper.
While skin experts advise leaving all spots well alone, when it comes to nodules, advice against at-home squeezing becomes more serious. “They cannot be squeezed and any attempts to do so will result in significant trauma and scarring,” warns Gamper.

If you experience severe or ongoing nodular breakouts, Gamper advises seeking help. “You should see a medical professional or dermatologist for treatment due to the high risk of scarring.”


Most prevalent on the face but also common on the chest, neck, back and arms, like nodules, boil like acne cysts are also considered a more severe types of acne that require medical treatment should they persist.

Unlike nodules, however, cysts can be large and are fluid-filled, but carry an equally very high risk of scarring, hence the need for medical advice early on.

Plus, “topical treatment is often ineffective when it comes to cysts, so medical assistance is needed to access prescription treatment options like high dose oral antibiotics or oral vitamin A derivative isotretinoin,” says Gamper.

Sandra Gamper, Aesthetic Doctor

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