Recognize the different forms of acne

Acne vulgaris is the medical term for juvenile pimples. Almost everyone has pimples to a greater or lesser degree. It is an inflammation of the hair-talgland complex. The causes include four main processes: overproduction of androgens, excessive sebum production, inflammation and proliferation of Cutibacterium acnes (formerly Propionibacterium acnes). Clinically, open and closed comedones, inflammatory papules, pustules and cysts can be seen in patients with different forms of acne. These different forms of acne require different treatment strategies.

Acne forms

1. Blackheads: open comedones or black heads

Called open comedones, they get their name from the fact that they appear as a black spot on your skin.

Comedones start just like any other pimple: Excess skin debris (also known as keratin) mixes with overproduction of sebum — the natural oil in your skin — clogging your sebum drain.

What makes open comedones different is that the pore is open to the air. Oxygen from the air causes a chemical reaction — oxidation — with the material in your pore, turning it black.

How to treat.

Focus point is to make sure the sebum can get out easily. Agents such as fruit acids (AHA / glycolic acid), salicylic acid, benzoyl peroxide, retinol, tretinoin and adapalene, ensure that your blackheads are unclogged, as it were. This prevents the formation of blackheads.

2. Blackheads: closed comedones or whiteheads

Whiteheads, also called closed comedones, are similar to open blackheads, except that instead of being open, the pores are closed by a layer of skin.

How to treat.

It is very tempting to squeeze out the whiteheads, to snap them. Try to avoid this to avoid scarring and slow down the healing process.

As with blackheads, the best treatment is to wash your face with glycolic acid, for example, and use oil-free, non-comedogenic products (skin and sun protection).

3. Pimples

Pimples initially contain fluid and later pus. They appear as large white bumps surrounded by red, inflamed skin. Usually causes bacterial growth (cutibacterium acnes) in clogged follicles. These bacteria thrive in low-oxygen environments.

How to treat.

Smaller pimples may go away without treatment, but you can also use topical benzoyl peroxide, tretinoin, or adapalene. They are mainly antibiotics that inhibit the growth of bacteria. This can be done topically such as clindamycin or erythromycin lotion or antibiotic tablets (minocin, doxycycline). For extensive and moderately severe acne, a combined treatment is chosen, for example adapalene and antibiotic tablets. Both can reduce inflammation and kill bacteria growing in the follicle and on the surface of the skin.

4. Papels

Papules are firm, raised spots that are usually less than one centimeter in diameter. They can have different shapes and colors. They start out firm, and after a few days can become full of pus and become a pimple.

How to treat.

Here it is important to avoid further irritation in the area. Do not exfoliate your skin and be careful when cleansing with warm water. You can wash your face with a glycolic acid cleanser.

It is wise not to apply makeup on papules so that the area does not close off too much. Bacteria can thrive in an enclosed area and cause inflammation.

5. Cysts

Cystic acne is considered the most severe form of acne. Like pimples, cysts are caused by clogged pores under the skin’s surface. They contain fluid or pus and can be large and red and are usually painful. This type of acne produces scarring in the form of dents in the skin. Sometimes hypertrophic scar and in severe situations keloid (thickening outside original site) formation.

How to treat.

In this situation, proper treatment can be obtained from a dermatologist to reduce or prevent permanent scarring. Internal antibiotic therapy or even isotretinoin tablets are an option. A corticosteroid cream is often given with it to “cool” the inflammation externally

Isotretinoin (contains vitamin A) is a drug that suppresses sebum production. In addition, isotretinoin has an inhibitory effect on the cornification in the drainage duct of the sebaceous gland and suppresses the inflammatory response. The most common side effect is dehydration of the lips, nasal mucosa, eyes and skin. Sometimes liver enzymes and fats in the blood may rise during treatment. Therefore, blood tests are needed. Isotretinoin has serious risks when used during pregnancy.

Acne Types

Myths about acne

Acne is not contagious; it is not transmissible to anyone else.

An allergy to food is not the cause of acne.

Chocolate has not yet been well established to cause acne. Studies on this are conflicting.

Poor hygiene is not related to acne. However, it is better to wash your face with a mild cleanser twice a day instead of once a day.

Taking extra mulitvitamins does not improve acne. An excess of vitamin B12 can even aggravate pimples. Learn more about vitamins, what you didn’t already know. Vitamins are not the same as minerals such as zinc, copper, calcium, etc.

After puberty, acne disappears like snow in the sun. At 25-75% of 12-25-year-olds and 10% of 30-40-year-olds suffer from pimples.

Having acne does not represent anything. Acne can lead to many psychological problems such as depression, social isolation, obsessive hygiene behaviors such as washing face with soap many times a day and even increased suicidal thoughts and attempts among young people.

What can the skin therapist do for you?

In addition to the medicinal treatment of acne, the skin therapist can also apply treatments for acne.

  • Chemical peeling: With a chemical peeling, the top layer of skin is thinned. This stimulates exfoliation of the skin, dissolves sebum and inhibits inflammation. Red spots, which often remain after acne, also become lighter and the skin gets a better condition in general.
  • Manual (manual) cleaning: The skin therapist cleans the skin and frees it as much as possible from blackheads and inflammation.
  • Product advice for at home.

How to use Iconic Elements Cleansing Milk (Step 1) and Cleansing Lotion (Step 2) in the skin care routine for acne has specific benefits that contribute to effective cleansing and reducing acne:

Step 1: Iconic Elements Cleansing Milk

  • Removal of impurities and makeup: Cleansing Milk is the first step of your cleansing routine. It is designed to remove impurities, makeup and excess oils from the skin’s surface. This is crucial because a buildup of oil, dirt and makeup can contribute to clogged pores, which can in turn worsen acne.
  • Without alcohol: An important feature is that Cleansing Milk does not contain alcohol. Alcohol can dry out and irritate the skin, and in some people it can lead to increased sebum production to compensate for the dryness. This can possibly worsen acne. Cleansing Milk thoroughly cleanses the skin without affecting the skin’s natural moisture barrier.

Step 2: Iconic Elements Cleansing Lotion

Deeper Skin Cleansing: Cleansing Lotion is the second step that provides deeper cleansing. It penetrates deeper into the pores to remove accumulated impurities, excess sebum and acne-causing bacteria. This is especially important for people with acne, as clogged pores can be a breeding ground for acne bacteria.

Complete cleansing: By using both Cleansing Milk and Cleansing Lotion, you ensure a thorough and complete cleansing of your skin. You start by removing surface impurities and makeup with Cleansing Milk and then go deeper with Cleansing Lotion to unclog pores and clear skin of acne-causing factors.

For more advice, please contact our skin therapist. She can give advice on products that you can use at home and which treatment options are suitable for you.


Xu S, Zhu Y, Hu H, et al. The analysis of acne increasing suicide risk. Medicine (Baltimore). 2021;100(24):e26035.

Choi JM, Lew VK, Kimball AB. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Pediatr Dermatol. 2006 Sep-Oct;23(5):421-7.

While you are here

Dermatitis perioralis is a rash most commonly seen in women between the ages of 16 and 45. But children between the ages of 7 months and 13 years are not spared either. The skin condition consists of small inflammatory papules and pimples and/or red/pink scaly areas around the mouth or eyes. For more info: Dermatitis perioralis

Picture of Dr. Francis Wu

Dr. Francis Wu

Dr. Francis Wu, een vooraanstaande dermatoloog, is de drijvende kracht achter Iconic Elements. Hij heeft sinds 2004 zijn expertise ingezet om een veilige en effectieve huidverzorgingslijn te creëren, geschikt voor zowel gezonde huid als huidproblemen. Iconic Elements, opgericht in 2016, is de eerste brede skincare lijn in Nederland ontwikkeld door een dermatoloog. Als medisch specialist streeft Dr. Wu naar het bevorderen van het welzijn van mensen door hoogwaardige en effectieve huidverzorgingsproducten te bieden. De proefdiervrije en vegan producten vermijden schadelijke chemicaliën en bevatten natuurlijke ingrediënten.
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