There are two major types of acne:
Non-inflammatory acne: clogged pores without redness. This form of acne is most responsive to typical acne treatments.
Inflammatory acne: Bacteria or the immune activity causes redness and swelling. It is likely more noticeable and is more likely to cause scarring and hyper pigmentation. Cystic acne is a type of inflammatory acne that often causes scarring.
The Journal of Health, Population, and Nutrition states that the global incidence of adult acne has been rising over the past two decades. Despite how widespread it is, many people still do not understand the differences between the unique types of acne. Acne manifests in distinct patterns, each arising from different causes and responding to specific treatments.
Acne is the most common skin condition in the United States, affecting nearly 50 million Americans each year, according to the American Academy of Dermatology.
Acne begins when a hair follicle becomes blocked with dead skin cells and oil naturally produced by the skin. What happens next determines how it appears on the surface. Understanding what type of acne you have can empower you to choose care that is appropriate for your skin rather than relying on trial and error.
Dermatologists classify acne into inflammatory and non-inflammatory categories. Non-inflammatory acne involves clogged pores with little to no redness and is often responsive to topical over-the-counter or prescription-strength treatments.
Whiteheads are clogged pores that remain closed at the skin's surface and form small, flesh-colored bumps. They commonly appear on the nose, chin, and forehead. The pore opening remains sealed, so trapped oil and skin cells remain beneath the skin surface. Typically, whiteheads do not hurt, but if pores remain clogged, they can persist.
Blackheads are open, clogged pores exposed to the air. Their dark color results from the material inside the pores oxidizing, not from dirt. They are often associated with excess sebum production, a natural oil produced by glands in the skin, and the buildup of dead skin cells. Blackheads frequently develop on the nose, chin, and cheeks and may recur without gentle exfoliation and topical treatment.
Inflammatory acne develops when bacteria or immune activity causes redness and swelling within the hair follicle. It may be more noticeable and more likely to leave marks known as post-inflammatory hyperpigmentation or PIH. PIH may appear as a flat, dark spot that remains after the blemish heals.
Papules are small, red, tender bumps caused by inflamed follicles. They may appear in clusters on the face, neck, or back. Typically, they do not contain visible pus. Touching or squeezing can worsen inflammation and delay healing.
When papules fill with pus, they are called pustules. They may appear red at the base, with a white or yellow center. Picking them may worsen inflammation and increase the risk of scarring. Instead, use a gentle cleanser daily, avoid poking them, and apply the acne treatment prescribed by your doctor.
Nodules are large, firm, and painful lumps that develop deeper in the skin surface and may last for several weeks. Because the inflammation occurs well below the pore opening, they often feel sore or painful even when not touched.
Over-the-counter topical products usually cannot reach them. Avoid poking, prodding, or attempting to drain the lesion at home. Prescription medication is often needed to reduce inflammation and quicken healing.
Cystic acne refers to deep, inflamed lesions. Unlike a cyst, which is a fluid-filled sac, these acne lesions form when the follicle wall breaks down beneath the skin, allowing inflammation to spread into the surrounding tissue. They are considered a severe form of acne and may be more likely to cause permanent scarring.
Home extraction or harsh spot treatments can worsen inflammation. A clinician may recommend oral medications, such as isotretinoin, to calm inflammation and help the cystic lesion heal safely.
In addition to common inflammatory and non-inflammatory acne, other triggers include:
Online acne care is an appropriate starting point for many people who deal with mild-to-moderate acne. With Counsel, you can get started by checking if you are eligible for free. You first chat with Counsel AI to securely share acne history, prior treatments, medications, labs, photos, and more. Counsel AI then integrates additional context from prior medical history to determine eligibility. If eligible, you can add a Counsel physician to your chat to review and explain your personalized treatment plan. They will also provide your initial prescription medication online so you can pick it up at your local pharmacy. Once your treatment has started, you will have access to three months of unlimited follow-ups with Counsel AI and a physician. These follow-ups will help you navigate side effects, monitor progress, and make adjustments if appropriate.
Patients can check if they are eligible for acne treatment for free. If eligible and you’d like to get started on your care plan, adding a doctor to the chat costs $29 (or free for members of Signature, Counsel’s premium subscription). This includes your consultation and initial prescription, as well as three months of unlimited follow-ups with Counsel AI and a physician.
Your final cost will depend on which treatment you choose and your insurance coverage. Several commonly used options are available for under $10 per month.
It is important to note that Counsel is designed for adults ages 18 to 75 with acne vulgaris; however, not everyone will qualify. We have clear exclusion criteria, and clinical safeguards are in place to help match the right patients to topical therapy while directing others to in-person evaluation when needed. Care with Counsel remains personalized and safe because our in-house physicians safeguard each interaction.
Explore how to get personalized prescription acne treatment online today. Get started on your journey to clear skin with Counsel.
The Counsel Health editorial team is a multidisciplinary group of writers and editors dedicated to delivering clinically grounded, evidence-based health information. Their work is informed by real-world care delivery and guided by physician expertise, ensuring content is accurate, accessible, and trustworthy. By translating complex medical topics into clear, practical guidance, the team helps readers understand their health, explore care options, and make informed decisions in a rapidly evolving healthcare landscape.
Dr. Rishi Khakhkhar is CMO at Counsel Health. A practicing emergency physician and founding team member, he leads the clinical team in building best-in-class asynchronous care models. Previously, he served as Medical Director of Mount Sinai’s Virtual Urgent Care, the health system’s largest telemedicine service, and led emergency department operations for Hospital-at-Home while supporting mobile integrated health initiatives across the care continuum.
Our content is created for informational purposes and should not replace professional medical care. For personalized guidance, talk to a licensed physician. Learn more about our editorial standards and review process.
