Types of acne — whiteheads, blackheads, papules, pustules and nodules explained

Key facts

• Comedones: whiteheads and blackheads
• Inflamed lesions: papules, pustules, nodules and cysts
• Acne is graded as mild, moderate or severe
• Scarring acne is treated as severe
• Treatment is matched to type and grade

Comedones: whiteheads and blackheads

Comedones are the starting point of acne. They form when oil and dead skin cells block a hair follicle. A closed comedone, or whitehead, is a small, skin-coloured or white bump where the opening stays covered. An open comedone, or blackhead, has a wider opening, and the dark colour comes from oxidised oil and pigment rather than dirt, so scrubbing does not remove it. Comedonal acne is common on the forehead, nose and chin. Topical retinoids such as adapalene are the cornerstone of treatment, often combined with salicylic acid or azelaic acid.

Papules and pustules

When a blocked follicle becomes inflamed, it turns into a papule, a small, red, tender bump without a visible head. A pustule is similar but contains visible pus at the top. These inflamed spots are what most people picture as acne. They respond to topical combinations such as benzoyl peroxide with a retinoid or a topical antibiotic. When papules and pustules are numerous, spread to the chest or back, or keep recurring, a limited course of oral antibiotics, or hormonal treatment for some women, may be added. Squeezing them increases the risk of dark marks and scars.

Nodules and cysts

Nodules are large, firm, painful lumps deep in the skin, and cysts are similar but softer and filled with fluid. They can last for weeks and often heal with scarring. Nodulocystic acne needs prompt medical treatment rather than over-the-counter products. Isotretinoin is usually the most effective option, given with monitoring, and individual painful nodules can be calmed with a small steroid injection. Other look-alike conditions, such as hidradenitis suppurativa in the armpits or groin, or boils, also cause deep lumps and are diagnosed by examination, so a dermatology review is important.

How acne is graded

Dermatologists grade acne to guide treatment. Mild acne mainly involves comedones with a few papules or pustules. Moderate acne has more papules and pustules, sometimes on the chest and back, with occasional small nodules. Severe acne includes many inflamed lesions, nodules or cysts, or any acne that is causing scarring or significant distress. The grade also considers how widespread it is and how much it affects your life. Grading is not fixed; acne can move up or down between visits, and treatment is adjusted accordingly. Photographs are sometimes used to track progress objectively.

Matching treatment to type

Comedonal acne responds best to retinoids and gentle exfoliants, while inflammatory acne often needs benzoyl peroxide and anti-inflammatory treatment. Nodulocystic or scarring acne usually calls for oral treatment such as isotretinoin. Chemical peels can support treatment of comedones and marks, and other forms of acne, such as hormonal acne along the jawline or acne caused by certain medicines, need tailored approaches. Fungal folliculitis and rosacea can be mistaken for acne. At Manhal Medical Center in Dubai, Dr. Abdullah Anis, Specialist Dermatologist & Venereologist, examines your skin, confirms the type and grade and explains the plan.

Acne is a medical skin condition. Effective treatment matches the type — comedonal, inflammatory, hormonal or cystic — and prevents scarring.

Prepared by the Manhal Medical Center editorial team · Updated: 2026-10-18 · Treating specialist: Dr. Abdullah Anis

This page is general information and does not replace a consultation. Suitability, risks and results vary between patients.