What does acne look like?

What do the different acne spots look like?

A pimple does not need a visible white tip to be acne. Papules have no pus, and nodules develop deeper in the skin. The distinction between a nodule and a cyst involves what is inside the lump, not just its appearance.1

Why do these spots form?

Acne affects the hair follicle and its oil gland. A follicle is the small structure that a hair grows from. Blockage and swelling produce different kinds of spots: blackheads and whiteheads are blocked pores without inflammation, while papules and pustules are inflamed. More severe acne can include deeper nodules and cystlike swellings. Hormones, bacteria and a family tendency can all contribute; the exact process is not fully understood.35

Blackheads are not caused by dirt, despite a name that sounds like a cleaning assignment. Pimples are not caused by dirty skin either. A dark spot in a pore is not a reason to scrub harder: gentle cleaning is the appropriate approach.6

What does acne look like on different skin tones?

All the main types of acne can occur in skin of colour. Redness is often less obvious, and dark marks after spots heal can be more prominent and last longer than the original breakout. Look at the shape and depth of a spot as well as its colour. Raised scarring called keloid scarring is more common in skin of colour after acne, particularly along the jawline, chest and upper back.2

Is it an active spot, a mark or a scar?

A completely flat patch where a spot used to be can be a leftover colour change rather than another breakout or a permanent scar. These patches can be pink, red, purple, black or brown. Dark marks after inflammation are called postinflammatory hyperpigmentation. They eventually fade, but some last a year or longer, with darker marks taking longer to clear.1

Acne scars change the skin's surface: some leave depressions, while others are raised. Scars can be permanent. Leaving acne untreated, or continuing with treatment that is not working, increases the risk of scarring. Having a close blood relative with acne scars also increases that risk.1

What does body acne look like?

Body acne can include the same small bumps, blackheads, pus filled pimples and deep lumps seen on the face. The chest and back are common locations. Acne can also occur on the shoulders, arms, legs and buttocks. Skin can feel oily, hot or painful, and spots can leave colour changes or scars.34

What does back acne look like?

Back acne can be a mixture of blocked pores, small inflamed bumps, white or yellow pus filled spots and larger, painful lumps. Recently healed spots can leave red or dark flat marks, while scars alter the texture. Back acne is not a separate spot type: the location changes, but the same acne features can appear together.2

Can something else look like acne?

Yes. Several conditions can resemble acne, and both acne and rosacea can cause redness and breakouts. A stubborn breakout is not automatically acne. Equally, acne treatment that worked during your teens can stop working in adulthood even when the condition is still acne. A dermatologist can help identify the condition and choose treatment.7

Acne is usually diagnosed by examining the skin, without tests. Unusual features can call for additional checks, such as a skin swab or, in some women, hormone tests. Appearance helps guide assessment, but it is not a reason to assume every bump has the same cause.45

What should you do if it looks like acne?

1. 1Wash gently twice a day, and remove makeup at the end of the day. Avoid scrubbing.
2. 2Choose skincare and makeup labelled noncomedogenic, meaning formulated not to clog pores.
3. 3Ask a pharmacist about an acne treatment such as salicylic acid or benzoyl peroxide. Follow the product directions and apply sparingly.
4. 4Leave spots alone. Picking, squeezing and scratching can cause infection, slower healing and scars.
5. 5For body acne, wear loose, breathable clothing, especially during exercise or sweating.

Acne products can cause redness, dryness or excessive peeling. Benzoyl peroxide can also bleach towels and clothing. Persistent acne can need prescription treatment rather than more washing. Pregnancy changes treatment choices: isotretinoin must not be taken during pregnancy because it causes severe birth defects.4

How long do acne spots last?

Individual spots usually last less than two weeks, but deeper bumps and nodules can persist for months. Treatment can take six to eight weeks to show a response, and acne can flare again. One spot healing does not mean the condition has cleared. Acne can continue into middle age rather than ending automatically after the teenage years.24

When should you get medical help?

• See a doctor for lots of spots, deep or painful lumps, scarring, or acne that is not improving with treatment.
• Get medical help for signs of infection, including hot, swollen skin. Redness can be harder to see on brown and black skin.
• Seek help if acne is affecting your mental health.
• Seek urgent assessment if severe acne comes with fever, joint or bone pain, or extensive or ulcerated skin lesions.