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Acne is a skin disorder affecting oil glands. Oil glands, also called sebaceous glands, produce oil or sebum, which is a normal function of the skin and helps moisturize it. They are located in the middle layer of the skin near hair follicles and are distributed almost all over the body. The most significant density of those glands is on the face and scalp. They open into the hair follicles.

When those glands produce more oil than usual, and the dead skin cells build up in the pores, hair follicles become clogged, you may notice acne signs.

The common acne is called acne vulgaris in medical terms. So, let’s take a look at acne vulgaris symptoms.

1. Blackheads – One of the Most Common Acne Symptoms

Blackheads are also called open comedones because they are not covered with the skin and are open to the air.  They look like black dots, as if the dirt is in the pores. Actually, blackheads are clogged hair follicles. Oil and dead skin cells clog them. The oil contains pigment melanin, which is exposed to the air and gets oxidized. Oxidized melanin and reflecting light, not the dirt, make blackheads look dark. 

First Acne Symptom - Blackheads
Blackheads Are One of the Most Common Acne Symptoms (Essentials Collection via Getty Images)

Blackheads might be slightly raised but do not cause pain or itching. They are usually caused by excessive oil production. And excessive oil secretion has many causes, but mainly blackheads are caused by hormonal changes.

Sometimes other conditions, such as sebaceous filaments and trichostasis spinulosa, look like blackheads and might be mistaken. Read more about blackheads and other conditions and how to solve these problems.

2. Whiteheads

Whiteheads, unlike blackheads, are called closed comedones because they are covered with skin, and the pores are closed. They form when the hair follicles get clogged with dead skin and oil. Oil, called sebum, cannot reach the surface of the skin.

Second Acne Symptom - Whiteheads
Whiteheads (Essentials Collection via Getty Images)

Whiteheads look like small white or yellow bumps. Because the pores remain closed, sebum has no contact with the air, melanin cannot oxidize, and whiteheads remain white. They are not inflamed and not painful.

Blackheads and whiteheads are both considered non-inflammatory or comedonal acne symptoms. When bacteria get involved and inflammation starts, you may see inflammatory acne symptoms.

3. Papule

A papule is one of the inflammatory acne symptoms. The same causes induce them as comedones: excessive oil production and build-up of the dead skin cells, which lead to clogged pores.

But unlike blackheads and whiteheads, bacteria that live on the skin’s surface penetrate the pores and cause inflammation and papules.

Acne Papules
Acne Papules (Essentials Collection via Getty Images)

Papules look like 5 – 10 mm or smaller solid red bumps. Sometimes they may not be seen on the skin’s surface but can be palpable. They might be painful to the touch. Papules do not contain pus. But most papules store up pus in a few days and become pustules.

4. Pustule

Very similar to papules, only pustules contain pus or fluid. They usually evolve from papules and are around the same diameter (5-10 mm). Only papules look like solid red bumps, and pustules look like raised red bumps with a whitish or yellowish center.

Acne Pustule - on of the most common acne symptoms
Acne Pustule (Essentials Collection via Getty Images)

Pustules contain pus due to inflammation. The pores are trying to get rid of germs, excessive oil, and dirt, so the body recruits the white blood cells, leukocytes, to the site of inflammation. Dead white blood cells form pus.

5. Nodule

A nodule is a symptom of severe acne. The causes of nodules are all the same as hormonal acne. Also, nodules might be determined genetically.

Acne nodules - a sign of severe acne
Acne Nodules – a symptom of a severe acne (Essentials Collection via Getty Images)

Nodules resemble papules; only they are larger and more profound. They look like solid, painful to touch bumps, and are found deep in the skin. Nodules are larger than 10 mm in diameter. The color of nodules varies from skin tone to red.

Because nodules are located deep in the skin, they might cause scarring. Nodules may persist for a long time, sometimes even for several months. Prolonged inflammation may lead to scarring.

Another reason for scarring is picking or popping nodules. But there is nothing to pop. Nodules do not contain any fluid or pus that can be popped.

Nodules require treatment because they may leave your skin with scars or dark spots; also, they may develop into cysts over time.

6. Cyst – a Symptom of a Severe Acne

Cysts like nodules reside deep in the skin but contain pus or fluid, unlike nodules. Cysts develop when other acne pimples merge and create large sacs of fluid. The skin tries to fight this inflammation, and the skin’s immune system responds. Like in the case of pustules, white blood cells gather at the site of inflammation and fill up the cysts with pus. Cysts are usually painful or itchy.

Cystic Acne
Cystic Acne (Hellenic Dermatlas)

Cysts may pop, and the bacteria and inflammation may spread, causing more acne breakouts or cystic acne.

Cystic acne is more common in people who are undergoing hormone shifts. Cysts may be found in teenagers, men, or women who experience increased androgen levels, stop birth control, and go through menopause.

Like nodules, cysts may lead to acne scars if not treated properly.

7. Enlarged Pores

Enlarged Pores - Might Be One of the Acne Symptoms
Enlarged Pores – Might Be One of the Acne Symptoms (Essentials Collection via Getty Images)

Enlarged pores are associated with acne. Many factors cause pores to enlarge. The most common causes are:

  • Excessive sebum production – increased oil secretion;
  • Loss of skin elasticity around the pore – this may happen with age;
  • Increased hair follicle size – this might be due to the clogged hair follicle;
  • Comedogenic products may clog the pores and enlarge them
  • Prolonged sun exposure – damages the fibers of the skin and makes pores sag and enlarge.

8. Increased Sebum Secretion

Oil glands near hair follicles compose one pilosebaceous unit with hair follicles and produce sebum. This secretion increases dramatically in the teenage years because of the significant hormone shifts. This may lead to oily, greasy skin or acne breakouts.

Oily an clear skin
Oily skin and clear skin (Essentials Collection via Getty Images)

Other factors of the increased sebum secretion are stress due to high cortisol, over-cleansing skin (which may remove natural skin oils and oil glands may want to substitute them), and lack of hydration (skin tries to moisturize itself then).

9. Fungal Acne Symptoms

Fungal acne actually is folliculitis but is often mistaken for acne. A yeast fungus causes this folliculitis. Acne treatment does not help.

Fungal Acne
Fungal Acne (Shutterstock)

The skin is usually very itchy. Small, usually 1 – 2 mm in diameter, uniform skin tone, or red bumps form clusters. The most common locations are the hairline, forehead, sides of the face, and chin, but they might be found anywhere.

Greasy, sweaty skin, tight clothes, and antibiotics may lead to fungal acne.

10. Itching Pimples

Usually, acne breakouts aren’t itchy, but sometimes they might become irritated. Some conditions, such as fungal or bacterial folliculitis, may cause itchiness.

Itching pimples - a symptom of acne
Itching Pimples – a Symptom of Acne (Essentials Collection via Getty Images)

Other factors that may lead to itching pimples are:

  • Side effects of anti-acne skincare, such as salicylic acid, benzoyl peroxide, and medications;
  • Allergies to acne treatment;
  • Dry skin;
  • Heat, sun, sweat;
  • Healing acne – healthy layers of the skin change damaged skin and may cause flaking and itching.


So, let’s wrap up. Acne is a skin condition affecting a unit of the oil gland and hair follicle. When oil glands increase secretion of sebum, and the turnover of the skin cells on the surface is decreased, pores get clogged, and you may see acne signs.

The most common acne symptoms are blackheads, whiteheads, papules, and pustules. In more severe acne forms, nodules and cysts develop.

Accompanying acne symptoms are enlarged pores, excessive sebum production, and itchiness.

All acne signs should be managed because mild acne breakouts may lead to severe forms of acne and even cause long-lasting post-acne scars or marks.

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