Signs and Symptoms of Acne

The symptoms of acne begin with a plugged pore, which then causes a lesion on the skin. This can range from non-inflamed bumps and blackheads to inflamed, red pimples and pustules. The most severe symptoms are seen in cystic acne, which can lead to scarring.

Frequent Symptoms

Blemishes are the core symptom of acne, and you can easily see or feel them on yourself, your kids, or other people in your care. Most people have a combination of both non-inflamed and inflamed blemishes.

Acne blemishes very often appear on the face, but acne can also develop on other areas of the body, like the neck, chest, shoulders, back, and butt.

Non-Inflamed Acne Symptoms

Non-inflamed acne, also called comedonal acne, doesn't cause blemishes that are red or painful. Symptoms of non-inflamed acne include bumps or bumpiness across the skin's surface or uneven skin texture. The lesions are comedones—blocked skin pores that may be open (blackheads) or closed (milia or whiteheads). Even if comedones are not easily visible, they will make the skin feel rough or like sandpaper.

Non-inflamed acne breakouts include:

• Blackheads (open comedones)
• Milia (non-inflamed whiteheads)
• Closed comedones (non-inflamed bumps)
• Microcomedones (pore blockages too small to see)

Inflamed Acne Symptoms

Inflamed acne breakouts result in red, swollen pimples. Inflamed acne can be mild, with just occasional breakouts here and there, or it can be more severe, resulting in deep blemishes. These blemishes may not only be swollen, but they can also ooze, crust, and scab over.

Inflamed acne breakouts commonly include:

• Papules (red, raised bumps that may be small or large)
• Pustules (red, inflamed, with a white head)

While nodules and cysts—which are larger than a typical pimple and develop in deeper layers of the skin—are less common forms of inflamed acne lesions, they can be seen in more severe cases.

Rare Symptoms

Cystic acne is the most serious form of inflamed acne. People with nodulocystic acne develop acne cysts and nodules that are significant in terms of quantity and severity.

• Acne cysts feel like soft, fluid-filled, painful lumps under the skin's surface.
• Acne nodules are hard, painful, substantial-size lumps under the skin's surface. They take a long time to heal.

Moderate to severe acne is seen in 14% of high schoolers.

Complications/Sub-Group Indications

Acne can lead to complications, or it may be of special concern in certain populations.

Excoriated Acne

Excoriated acne is a complication of picking at or scratching your acne lesions (or imagined lesions) to the point of wounding the skin. This problem occurs more frequently in women, and it may be part of obsessive/compulsive excoriation disorder.

Constantly squeezing or picking at the skin causes angry red bumps, open red sores, scratches, crusts, and scabs. This can progress to a nodule or cyst.

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation is the medical term used to describe dark, discolored spots left behind after an acne blemish has healed. It's a very common problem and most people with acne will develop these marks to some degree. Luckily, post-inflammatory hyperpigmentation is not a true scar and, in most cases, will fade over time.

Scarring

Inflamed acne breakouts can often cause depressed or pitted scarring, or ice pick scars (long, narrow impressions in the skin). For some people, acne blemishes also cause hypertrophic, or raised, scars.

Acne in People With Diabetes

Inflamed acne breakouts are of increased concern for people with diabetes because they have less resistance to skin and soft tissue infections. Some types of prescription treatments for acne, such as Zenatane (isotretinoin, a vitamin A derivative), may affect blood sugar levels and your healthcare provider may want to monitor you closely if you use them.

Acne in Pregnant Women

Due to the hormonal fluctuations of pregnancy, a woman may develop acne or have a new breakout. Some prescription acne drugs are not recommended during pregnancy as they can cross the placenta and lead to birth defects, miscarriage, and stillbirth.

When to See the Healthcare Provider

The more severe the acne, the higher the chances of scarring, so it's important to treat inflammatory acne as quickly as possible. This often means seeing a dermatologist for help.

As acne is very rare in children ages 1 to 7, a child should be seen by a healthcare provider to determine the cause of the rash. Pre-teens who develop acne often get more severe acne in their teen years, so beginning treatment early may help reduce problems later.

A Word From Verywell

You are likely to experience the symptoms of acne at some point in your life. A blemish or brief outbreak before an important occasion might be distressing, but it should heal if you take good care of your skin and avoid scratching or pinching the lesions. Ongoing or more severe outbreaks can be treated so they will occur less frequently and you can prevent scarring.