Inflammatory acne is a type of acne breakout that causes the skin to become red, discolored, swollen, and inflamed. Like other types of acne, inflammatory acne is caused by bacteria, oil, and dead skin cells blocking pores. However, unlike non-inflammatory acne such as blackheads or whiteheads, inflammatory acne triggers an immune response that causes inflammation.
If you have inflammatory acne, you may have small or large inflamed pimples, nodules, or cysts. These rashes typically form on the face, back, chest, and shoulders. Inflammatory acne can also be very painful and increases the risk of scarring.
Over-the-counter, prescription, and specialty treatments are available to help treat existing breakouts and prevent inflammatory acne from recurring.
Inflammatory acne causes moderate to severe discolored and swollen acne. There are several types of acne:
- papule: Papules, commonly called acne or zit, appear as raised, red, or discolored bumps on the skin. These are located on the surface of the skin.
- pustule: When papules fill with fluid called pus, they turn into pustules. This type of acne becomes inflamed and contains white or yellow pus.
- nodule: A hard lump forms under the skin. On the surface, it looks like a solid pink, red, or purple bump. These are often more painful and larger than pustules or papules.
- cyst: These are fluid-filled bumps that form deep beneath the skin. They are usually large, painful, and filled with pus. Cysts are the most serious type of inflammatory acne.
Inflammatory acne typically appears as red and pink bumps on lighter skin tones, or as red and purple bumps on darker skin tones. Some bumps may also have yellow or white pus inside them. These bumps may be superficial or appear to protrude from beneath deeper layers of the skin. Increased swelling and inflammation often make inflammatory acne painful.
This type of acne can appear anywhere on the body, but is more common on the face, chest, shoulders, and back. You may have one small blemish or multiple inflammatory acne lesions. Nodules and cysts are usually larger than acne and are more likely to scar.
As with other forms of acne, clogged pores cause inflammatory acne. Pores are small openings in the skin that hold hair follicles and contain pores. sebaceous The (oil) spring is underneath it. These glands produce oil (also called sebum) that helps soften hair and skin.
Bacteria, dead skin cells, and sebum can build up in pores, causing them to clog, stretch, and burst. As a result, the immune system instructs white blood cells to fight potential infections and bacteria in the pores. This immune response causes redness and swelling of the pores and surrounding tissues.
Inflammatory papules can occur when pores in the epidermis (the top layer of skin) become clogged and inflamed. When this begins to fill with pus, it turns into a pustule. Meanwhile, pores in the subepidermis (lowest layer of the epidermis) or dermis (middle layer of the skin) become clogged, causing nodules and cysts to form.
risk factors
Anyone can develop inflammatory acne, but certain factors that increase your risk of developing inflammatory acne include:
- age: Teens and young adults going through puberty are more likely to develop inflammatory acne. They produce more androgens (male sex hormones), which makes the sebaceous glands larger and increases oil production.
- hygiene: Not washing your face after sweating, picking at existing acne, or rubbing your skin can cause inflammatory acne. Some makeup, skincare, and haircare products can also clog pores.
- Hormonal changes and conditions: Hormonal fluctuations during the menstrual cycle or during pregnancy can cause inflammatory acne. People with polycystic ovary syndrome (PCOS) also have increased androgens, which can cause rashes. PCOS is a hormonal condition that affects the female reproductive system.
- genetics: People with oily skin types or a family history of acne are more likely to experience inflammatory acne. Researchers also discovered gene mutations (changes) associated with excessive sebum production and inflammation that may cause inflammatory acne.
- drug: Corticosteroids, lithium, and hormonal medications can cause inflammatory acne as a side effect.
- diet: Foods high in sugar can cause blood sugar levels to spike or drop, releasing hormones that increase oil production. People who consume a lot of dairy or high-glycemic foods (which raise blood sugar levels quickly) may also experience more breakouts.
A dermatologist (a doctor who specializes in skin, hair, and nail conditions) will perform a physical examination of your skin to determine whether you have inflammatory acne. Skin biopsies and other laboratory tests are not needed to diagnose inflammatory acne.
If your dermatologist believes that an underlying condition is causing your inflammatory acne, additional diagnostic testing may be needed to rule out other conditions.
Treatment of inflammatory acne includes removing existing breakouts and preventing future breakouts. A basic skin care routine that includes cleansing, moisturizing, and sunscreen is a good start. Inflammatory acne can be treated with a variety of over-the-counter (OTC) or prescription topical treatments. Your dermatologist may also suggest oral medications or treatments that target more severe inflammation.
Over-the-counter acne treatment
Over-the-counter (OTC) acne treatments applied directly to the skin can often clear up acne, including:
- Azelaic acid: These topical products (applied onto the skin) help unclog pores, reduce inflammation, and kill acne-causing bacteria.
- Benzoyl peroxide: This treatment reduces bacteria on the skin that can cause inflammatory acne.
- Niacinamide: This form of vitamin B3 helps reduce inflammation and regulate oil production.
- Differin (Adapalene): This retinoid (vitamin A derivative) is approved by the U.S. Food and Drug Administration (FDA) to treat acne and increase cell turnover to clear pores.
- Salicylic acid: This topical product helps remove dead skin cells that can clog pores.
- Glycolic acid: These alpha hydroxy acids (AHAs) quickly remove dead skin cells from the skin, exfoliating the skin and increasing collagen.
prescription acne treatment
If OTC acne treatments don't improve your inflammatory acne, your dermatologist may offer prescription-strength creams containing azelaic acid, benzoyl peroxide, or salicylic acid. Other prescription medications used to treat inflammatory acne include:
- Retinoids: Prescription retinoids, such as Tazorac (tazarotene) and Retin-A (tretinoin), can be applied topically to unclog pores and prevent future blockages.
- Winlevy (clascoterone): This FDA-approved topical medication treats inflammatory acne caused by hormonal problems.
- Antibiotic: Doxycycline (Vibramycin), minocycline (Minocin), or sarecycline (Seisara) is prescribed for several months to help reduce the bacteria that cause acne.
- Hormonal contraceptive methods: Combined oral contraceptives containing estrogen and progestin may help treat inflammatory acne caused by hormonal changes that increase oil production and breakouts.
- Spironolactone (Aldactone): This anti-androgen medication may help treat deep cysts caused by hormonal imbalances in people assigned female at birth.
- Accutane (isotretinoin): An oral retinoid that helps treat severe nodular acne that has not responded to other treatments. If taken during pregnancy, it may cause extreme dryness and serious birth defects.
- Archzone (Dapsone): Aczone, most often used as a gel, applied to the skin twice a day can help treat acne breakouts by preventing bacterial growth on the skin.
phototherapy
During light therapy, your dermatologist directs a laser to inflamed acne to help reduce inflammation and kill acne-causing bacteria. The different types of professional light therapy used to treat inflammatory acne include:
- Blue, red, blue + red lighting devices: They use visible light to treat cysts and nodules.
- infrared ray: This light therapy is FDA approved for the treatment of papules and pustules.
- Photodynamic Therapy (PDT): Before using lasers or light devices, dermatologists use solutions that make the skin more sensitive to light. This treats severe inflammatory acne, including cysts.
- Photo-pneumatic therapy: Intense pulsed light (IPL) laser combines with a gentle vacuum to remove excess oil and dead skin cells from pores. It is FDA approved for treating some acne.
Studies show that light therapy is more effective when combined with other topical acne treatments. You may need to undergo multiple treatments before you see results.
cortisone injection
If you have large, painful cysts or nodules, your dermatologist may inject corticosteroid medication into the acne lesions through a microneedle. These one-time injections help shrink the walls of swollen cysts, reducing pain, redness, and swelling. It also helps reduce the risk of scarring.
Changes to your skin hygiene habits and lifestyle can reduce your chances of developing inflammatory acne in the future. Here are some proven ways to help prevent inflammatory acne:
- Wash your face: Use a pH-balancing cleanser with benzoyl peroxide or salicylic acid twice daily to help control acne-causing bacteria.
- Follow your skincare routine. Don't expect immediate results. Acne treatment regimens may take several weeks or months to take effect.
- Shower after sweating: To prevent excess oil from getting on your face, shampoo your hair and shower after sweaty activities such as exercise.
- Avoid touching your skin: Touching, picking, popping, and squeezing an inflamed pimple transfers more bacteria to your face.
- Eat a balanced diet: Reduce your intake of processed foods and sugar. Focus on eating nutritious foods like fruits, vegetables, whole grains, and healthy fats.
- Stress Management: To prevent stress acne, try relaxing through yoga, exercise, reading, or meditation.
Inflammatory acne can increase the risk of skin infections, discoloration, and scarring. This is especially true if you are picking or popping a pimple or cyst. Common complications include:
- Post-inflammatory hyperpigmentation: Healed acne causes flat, dark spots to appear on the skin. These symptoms can take months to years to go away and are more common in darker skin tones.
- Post-inflammatory erythema: Flat red, pink, or purple marks left on the skin due to inflammatory acne. This is more common in light skin tones.
- Ice Pick Scar: A small, deep, sunken scar that looks as if a sharp object has pierced the skin.
- Rolling scars: Broad, shallow scar tissue forms under the skin, creating an oval or wavy scar.
- Boxcar Scar: A scar that forms a round or oval crater in the skin.
- Hypertrophic scars: A thick, raised scar that results from abnormal healing, usually on the jawline, chest, or back. It forms 1 to 2 months after the onset of the disease.
- Keloid: These are thick, raised scars that grow larger than the initial acne lesion. Scars usually begin to form 3 to 12 months after the rash appears.
- Papular scars: These are raised bumps that appear to be the color or lighter of your skin. These scars typically form on the nose, jawline, chin, or back.
Inflammatory acne outbreaks and scarring can also make your appearance uncomfortable. It is common to have low self-esteem and an increased risk of developing depression and anxiety.
Everyone feels insecure about their appearance from time to time, and we are our own harshest critics. If your condition is significantly impacting your mental health, consider seeing a mental health professional for additional support.
Inflammatory acne occurs when clogged pores trigger an immune response, causing inflammation. Everything from hormones and genetics to puberty and diet can increase your risk of inflammatory acne.
OTC acne medications, such as benzoyl peroxide and salicylic acid, can often help treat inflammatory acne. However, more severe forms may require prescriptions, light therapy, or cortisone injections. If you experience any of these symptoms, you may want to consult a dermatologist to help you find the right treatment for you.