Acne 101 – Comedones, Papules, Pustules, and Nodules

To continue the Acne 101 series, we’ll be talking about the different types of blemishes. Personally, when I have a pimple that’s what I call it – a pimple. I don’t care if it’s a comedone or a papule or whatever, I just need it to get off my face ASAP. But as we learned in the last post Acne 101 – Introduction, there’s a whole catalyst of events that occur on the surface of the skin and the different types of blemishes correlate with acne severity. We all might think we have really terrible acne, but what TYPE of pimple actually defines acne severity? This will also guide us when we start talking about recommended treatment depending on your acne type.


Comedones occur when the packed sebum, keratinocytes (skin cells), and bacteria rupture into the upper part of the hair follicle. For a more detailed explanation, please read the introduction post 🙂
Comedones are considered a non-inflammatory type lesions

Picture A: Closed Comedone AKA whiteheads
Appears as pale, slightly raised bumps. These may sometimes be difficult to see and you’ll more likely notice them when you touch your face (don’t touch your face!) and feel rather than see the bumps.

Picture B: Open Comedone AKA blackheads
Appears as a flat or slightly raised bumped with a dark center. These occur when the hair follicle becomes distended (swollen due to the pressure inside). Blackheads are black because the packed sebum oxidizes when it gets exposed to the air.

Picture C: Papules and pustules are considered inflammatory type lesions.
Papules are smaller than pustules and appear as small hard reddish bumps.
Pustules are similar to papules but are larger and filled with pus.

Picture D: Nodules occur when the follicle ruptures even further. This rupture leads to the contents in the follicle (the sebum, bacteria, and keratinocytes) being “spilled” into the other areas of the skin. Your skin freaks out and thinks these are foreign material (which it is because it shouldn’t be in that area of the skin) and responds by trying to enclose the area with tissue. Therefore, as you can see in the photo, the pimple is no longer a “neat” round circle,  but has formed random shapes to try to encapsulate the area.

What about cysts?
Large nodules used to be called cysts. Medical experts use the term nodulocystic to describe severe cases of inflammatory acne, but technically they say true cysts are rarely found in acne. They recommend abandoning the term “cystic acne” and using “severe nodular acne” – but I say call it whatever you want, I just want to get it off my face.


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