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.

Beautiful young woman removing pimple from her face in a bathroom home.
nensuria / Getty Images

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.

Timing of Breakouts

Acne breakouts are often related to hormone levels, which is a reason that they are seen in the teenage years. In women, ongoing acne breakouts are common in the week before menstruation and may continue to occur until menopause. Pregnant women often get acne outbreaks as well.

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 doctor 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 Doctor

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 doctor 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 sudden outbreak of severe acne in older adults might be a symptom of an underlying disease. This should be addressed by seeing a doctor for a full check-up or discussion of how ongoing conditions are being managed.

Frequently Asked Questions

What is the cause of acne?

Acne is caused when a hair follicle is blocked due to:

  • Excessive production of sebum (oil produced by the skin)
  • Build-up of dead cells within the follicles
  • Infection of the follicle by bacteria called Cutibacterium acnes
  • Release of inflammatory chemicals that cause redness and swelling

These processes are influenced both by genetics and hormonal changes. Stress, diet, and certain medications can also contribute.

What are the first signs of acne?

The first signs of acne are typically a blackhead or a whitehead. This can lead to the formation of small, red, tender bumps (called papules) and eventually a breakout of pimples as the papules fill with pus.

What is cystic acne a symptom of?

Cystic acne is a severe form of acne that causes the formation of large, red, painful cysts in the sebaceous glands. It is unclear why some people get cystic acne, although hormonal changes factor in strongly. Women, for example, will sometimes get cystic acne on the chin and jawline during their periods, while hormonal changes during puberty can cause cystic acne in some adolescents and teens.

What is the difference between acne and eczema?

Acne and eczema can sometimes look the same, but they are the result of entirely different processes. Acne is caused by blockage and infection of hair follicles, while eczema is caused by an inflammatory reaction to irritants. Eczema can lead to swelling, redness, and the formation of an oozing rash that may look like acne. This is especially true with papular eczema, which does not have the flaking and scaling common with other forms of eczema.

Does childhood acne get better as you age?

For most people, it does. Others may continue to have acne well into adulthood or suddenly develop acne later in life. This is more common in women than men. Causes of adult acne include:

  • Hormonal fluctuations during the menstrual cycle
  • Hormonal contraceptives
  • Stress and diet, both of which can stimulate sebum production
  • Cosmetics (possibly)

Can you cure acne?

No, but it can be treated successfully. For milder cases, over-the-counter remedies containing benzoyl peroxide may help. Moderate to severe cases may require treatment from a dermatologist, who may prescribe oral antibiotics, topical retinoids, azelaic acid, light therapy, or Aldactone (spironolactone). Improved skincare practices may also help.

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.

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