Acne will always be most prevalent for skin types with excess oil production and those prone to clogged pores (like skin types #1, #2, #3 and #4), but did you know that the formation of a blemish could start weeks (or potentially months) before it ever appears visibly? But when a pimple emerges, what is really happening underneath the skin? In this post, I’ll explain the breakout cycle from start to finish as well as helpful tips for treating it along the way to get it go to away fast.For starters, most infected blemishes will form due to pre-existing whiteheads and blackheads (blocked and hardened sebum deep in the pores) that become inflamed due to dead cells that line the hair follicle and create bacteria. This is why I always recommend regular deep pore cleansing facials to my acne-prone clients to keep their pores clear and decrease the chance of the formation of a blemish in the first place. You know all of those little small, whitehead-type bumps you have on your skin that have been there for a while? Well, those could be the cause of future blemishes.
But getting more technical, here is specifically what occurs when you get a blemish.
The follicle (also referred to as a “pore”) is a duct in the skin that contains a hair and is attached to the sebaceous glands that produce sebum (oil.) It is from the bottom of a follicle that a hair grows and through this follicle that sebum finds it way to the skin’s surface to keep skin moist. What also naturally occurs in the skin is the renewal process of cell turnover and the shedding of dead cells to make way for new ones. It’s also important to note that all follicles contain bacteria but in a non-acne skin type where there is not a blockage of the pore, oxygen can penetrate the follicle easily so bacteria can’t thrive and grow and cause problems.
In a normal, healthy and non-acne skin type (but one that still produces oil):
- Oil flows smoothly through the follicle
- Dead cells are naturally shedding in a consistent way
- Oxygen can get into the pore to keep bacteria at bay (bacteria can’t multiply in the presence of oxygen)
- The skin looks clear and balanced without the risk of blemishes
So the list above is what we want to have happen to lessen the presence of breakouts. With proper skin care products that focus on exfoliation, hydration and clearing clogged pores, this will help bring your skin into a proper balance and reveal a brilliant clarity. Skin types #1, #2, #3 and #4 all focus on doing exactly this.
In an acne-prone skin type:
- Over-active sebaceous glands create an increase of oil production
- This oil is sticky and thick so it clumps together and doesn’t flow through the follicle as easily
- There is an abnormal shedding of cells causing a build up inside of the follicles
- Dead cells mixed with the oil will block any oxygen from getting inside
- Bacteria, without the presence of oxygen, creates P. acnes bacteria which triggers an infection (breakout)
A blemish is: oil production consisting of sticky, thick oil + dead cells + lack of oxygen = a blocked pore lining leading to an infected blemish.
Once an infection has started, the bacteria increases and irritates the follicles along with the oil gland causing a rupture that triggers redness, inflammation and swelling in the reticular layer of the skin. The reticular layer of the skin is located in the dermis, which is where all of the blood vessels are located and they are home to the immune cells. When your body recognizes there is an infection, the immune system kicks in to aid in the healing process. When the follicle wall breaks (a rupture), the blood rushes to the follicle and the white blood cells (the immune cells) work fast to destroy the bacteria. At this stage, the blemish is called a papule, which is a red painful bump with no visible pus or whitehead on the surface. (This is the stage right before a full-blown blemish.)
Next, the white blood cells die off and accumulate in the follicle, along with other debris and fluids and form what is called, a pustule. This is when there is visible white pus, which is the result of dead white blood cells. (It’s important to note that not all blemishes will transition fully into a pustule.)
A cyst is larger than a pustule and is considered to be severe inflammatory acne that can be quite painful. Cysts are typically triggered by a surge in hormones, such as during a woman’s menstrual cycle. For some unknown reason, the skin’s oil glands become hypersensitive to this cascade of hormones, and react by overproducing sebum—so much, in fact, that the oil gland itself becomes engorged, swollen, and hardened with the excess. Unable to push the extra oil into the lining of the hair follicle (which leads to the surface of the skin via the pores), the gland bursts underneath the skin. This causes acute inflammation and irritation, and leads to the redness and soreness of cystic acne.
At any stage of the breakout cycle, if you leave it alone, it will eventually go away on its own assuming your immune system and healing processes are in good working order. If you choose to squeeze a blemish (like when a whitehead appears on the surface), it’s similar to draining an abscess or infected wound by removing the bacteria. However, the risk you take in squeezing at blemishes is that you can displace the infection so instead of coming out the surface, it can go deeper within the pore and cause more inflammation and irritation making a blemish last even longer.
For treating papules (a smaller red bump with no visible whitehead), there are a few options. One suggestion is to apply ice for ten minutes every 3-4 hours. Ice may help reduce a papule from going to the pustule stage by decreasing redness and inflammation. You might also consider applying an OTC cortisone cream twice a day, which also can reduce the visible inflammation. Lastly, if you dab on Anti Cyst Treatment twice a day, this can make papules settle down fast. (Originally I developed this product for cystic breakouts only to discover through feedback from our customers that it works really well on all types of blemishes. Bonus!) The focus with papules is to not pick at them or apply any traditional drying blemish spot treatments. Soothing, calming ingredients will usually give the best results for papules.
For treating pustules (a larger red bump with a visible whitehead), the best course of action is to not act the minute you feel it coming on, instead wait a day or two for the infection to appear on the surface. Waiting will allow you to effectively control the blemish without damaging the skin. Once the whitehead is truly visible, gently squeeze out the infection with your fingers wrapped in tissue and then apply a spot-drying treatment, like Night Time Spot Lotion, which will work its way into the follicle and eradicate any infection once the infection has been manually removed. If you apply a drying treatment before the whitehead is on the surface, it will simply dry out the surface of the skin and create dead cells keeping the infection trapped underneath even longer. I highly encourage you to read why most acne spot treatments don’t work. It’s one of my favorite posts.
Note: Some people find that spot treating with benzoyl peroxide the moment a pustule appears can help it from getting so big so you might try experimenting with that. However, if you use too much of it, you can get a lot of dryness/dead cell build up which is what we are trying to avoid.
For treating cysts (a large, deep and painful bump with no visible whitehead), there are several options. Similar to a papule, you can apply ice for ten minutes every 3-4 hours. (This tends to work better for papules since there is less infection, but you can certainly try this for cysts.) Another option is to schedule an appointment with a dermatologist to get a cortisone injection. The third option is to apply Anti Cyst Treatment the moment it appears. For cysts, these are the most effective solutions for this stubborn type of blemish.
Once the infection has been broken through the skin’s surface (mainly for pustules), your skin can be left with a scab, especially if you picked at it. The dead cells associated with the scab will eventually dissolve but you’ll be left with a red or purple scar known as post-inflammatory hyperpigmentation (PIH), which is an increase of melanocytes (melanin-producing cells) in the epidermis which then releases more pigment. Eventually, these discolored cells will settle down and the new cells will replace the darkened scarred ones due to the natural cellular turnover and shedding process of the skin.
For papules and cysts which typically do not break through the top layer of the skin, there will still be discoloration as the infection stretched and damaged the surrounding tissue resulting in an increase in melanin activity. Especially for cysts, these lesions start so deep in the skin, scarring (red, dark and purple marks) is an all-too-common side effect.
For treating discolored scars leftover from all types of blemish, exfoliation and skin-brightening is your best option. Post-Breakout Fading Gel is very effective for doing both of these so you’ll get a much quicker recovery. Read more tips for fading your acne scars.
So, why do some people get breakouts and others don’t? Other than these 11 possible causes, as with all blemish-prone skin types, nature has a twisted sense of humor; the true underlying causes for blemishes, while still mysterious, likely involves genetics…or simply a case of bad luck.
I hope this gives you some great insight in how to care for your blemish-prone skin.
Looking for our most comprehensive solution for breakouts? Shop our Zit Care Kit, complete with everything you need to tackle blemishes at every stage.
Read: What’s The Best Spot Treatment For Blemishes?
Read: Five Ways To Hydrate Oily, Acne-Prone Skin Without Causing Breakouts
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Celebrity Esthetician & Skincare Expert
As an esthetician trained in cosmetic chemistry, Renée Rouleau has spent 30 years researching skin, educating her audience, and building an award-winning line of products. Trusted by celebrities, editors, bloggers, and skincare obsessives around the globe, her vast real-world knowledge and constant research are why Marie Claire calls her “the most passionate skin practitioner we know.”