Here’s What Your Acne Breakout Is Actually Telling You

Updated: May 01, 2020

Could you tell a pustule from a pimple? Why do you break out only on your chin? We know that not all acne is equal, which is why knowing these breakout basics will help you clear up your type of spots for good.

Acne happens when oil glands are activated

You probably encountered your first zit at puberty. For most people, that’s when adrenal glands begin to pump out hormones that activate sebaceous (oil) glands. The glands make more oil, which can clog pores, leading to irritation and acne. Even though oil is a natural lubricant that protects the skin, “under certain circumstances, cells that are close to the surface block the openings of the sebaceous glands, and cause a buildup of oil underneath,” explains Melissa Aardema, a licensed medical aesthetician in Agoura Hills, California. “This oil stimulates the growth of bacteria, which live on everyone’s skin and can very easily multiply and cause surrounding tissues to become inflamed.” (Here are more sneaky reasons you could be breaking out.)


There are two main types of blemishes

There are many types of blemishes, but the two most common are comedones and inflammatory lesions. Comedones are blackheads and whiteheads, while inflammatory lesions are red and raised bumps, pimples, and cysts. “Blackheads and whiteheads are essentially clogged pores with either a black or a white top,” explains Joshua Zeichner, MD, director of Cosmetic & Clinical Research and assistant professor of dermatology at Mount Sinai in New York City. “Inflammatory pimples are red, raised, and sometimes pus-filled or painful.”


Acne falls into three categories

If you only suffer from the occasional zit, you may not know that acne is classified into mild, moderate, and severe categories. According to former first lady Michelle Obama’s personal aesthetician, JoElle Lyons-Lee, founder of JoElle SkinCare, you have mild acne if you have just a few whiteheads or blackheads; moderate acne if you have a “considerable amount” of blackheads, whiteheads, and inflamed pimples; and severe acne if you are experiencing “multiple cystic nodules under the skin.”

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A zit isn’t always just a zit

Before trying to figure out the best way to treat your acne, it’s important to know the type of breakout you’re experiencing. “If the inflammation is right near the surface, you’ll get a pustule; if it’s deeper, a papule (pimple); deeper still and it’s a cyst,” Aardema explains. If the oil breaks through to the surface, the result is a whitehead, but if the oil becomes oxidized (that is, acted on by oxygen in the air), it changes from white to black, and the result is a blackhead.


Different types of acne need different treatment

Mild to moderate acne can usually be treated with over-the-counter products and good skincare, but someone suffering with severe acne would most likely need to see a dermatologist or, in some cases, an aesthetician. (Although an aesthetician can’t make a diagnosis or prescribe acne medication.) Regular washing with a gentle, oil-free cleanser and moisturizing with oil-free, non-comedogenic formulas can help to maintain acne-free skin. It’s especially helpful if one or both has alpha hydroxy acids, such as glycolic acid or salicylic acid. These can help dissolve the bonds that keep dead skin cells stuck in place, blocking your pores. And as much as you want to pop that whitehead, don’t. Leave that to the experts. “Blackheads and whiteheads are on the surface, so you can usually remove them quite easily with steam and a comedone extractor,” Aardema says. “But pimples may need to be opened with a needle, and cysts usually require a steroid injection.”


Where you break out matters

Our experts agree that the most common areas people break out are the face, chest, shoulders, and back. Allergies, food sensitivities, lack of sleep, and poor diet can all lead to breakouts in these areas. For example, your body wash or laundry detergent may be aggravating your back, chest, or shoulder acne.

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Why you may be breaking out on your face

Depending upon where the breakouts are on the face, they can indicate a hormonal imbalance or some other concern. A 2016 study in Clinical Cosmetic and Investigational Dermatology found that acne around the jawline and on the chin can be caused by hormone issues. Breakouts on your cheeks could be due to a dirty pillowcase or mobile phone. If you experience whiteheads or blackheads near your hairline, it may be due to heavy hair products, suggests Dr. Zeichner.


Age plays a role in acne too

Teenagers tend to break out more in the T-zone (forehead, nose, chin, and around the mouth), while adult women may experience breakouts in the lower part of their face and jawline. Teen acne is the result of hormones stimulating the sebaceous glands to make too much sebum. In adults, it can be hormone fluctuations caused by menopause that play a role in this placement pattern. (Read more about the facts and myths about adult acne that will help you on your way to clearer skin.)

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Don’t forget about your diet

There’s preliminary evidence that specific foods may cause breakouts. Our skincare experts say that diets high in dairy, sugar, and fats may promote an inflammatory response in the body, which may lead to acne. But ultimately, “how your skin reacts to what you eat just depends on your own personal makeup,” Aardema says. “In fact, there are people who eat a very poor diet and hardly ever experience breakouts or acne,” adds Lyons-Lee. But just in case, check out the foods that may improve your acne (and a few that could make it worse).