Blackheads, papules, pustules: Understanding the Different Types of Acne to Better Prevent Them

Not all pimples are the same, and most importantly, they don’t all follow the same pattern. A blackhead, a red, painful pimple, and a microcyst under the skin: these are three different stages of the same process, not three separate problems. Understanding this progression usually changes how you respond—and helps you avoid the most common reflex, which is to treat every pimple as an emergency that needs to be eliminated immediately.

A Common Starting Point: The Blocked Follicle

According to the MSD Manual, acne originates in the pilosebaceous follicle, a small structure that consists of a fine hair and a sebaceous gland. When sebum production increases and dead skin cells are not shed normally, the follicle becomes clogged. It is this initial plug—which is invisible or barely noticeable—that gives rise to all subsequent types of lesions.

The French Society of Dermatology distinguishes between two main types of lesions based on this same underlying mechanism: retention lesions, known as non-inflammatory, and inflammatory lesions, which occur when bacteria naturally present on the skin proliferate within the blocked follicle and trigger an immune response. This excessive sebum production is itself largely driven by androgen hormones, which explains why breakouts often follow a predictable pattern rather than occurring at random.

Open and Closed Comedones: The Non-Inflammatory Phase

An open comedone, or blackhead, is a blocked follicle whose contents remain exposed to the air: its dark color results from the oxidation of sebum and melanin. A closed comedone, often called a microcyst, forms beneath a thin layer of skin: a small, hard bump that is sometimes barely visible. Neither of these forms is yet inflammatory—which is why they are neither red nor painful, unlike the next stage.

A blackhead, a red pimple, a microcyst: three different stages of the same process, not three separate problems.

Papules and Pustules: When Inflammation Sets In

When the blocked follicle becomes inflamed, a papule appears: a small, red, tender bump with no visible pus. If the inflammation continues to progress, it can develop into a pustule, with pus filling the center. It is at this stage that the urge to pop or scratch causes the most damage: touching it spreads the inflammation to the surrounding tissue and increases the risk of a permanent scar.

Lumps and Cysts: When It's Time to See a Doctor

In the most severe cases, the inflammation extends deep into the skin and forms nodules or cysts: larger, often painful lesions that can sometimes take several weeks to resolve. The MSD Manual and the French Society of Dermatology agree on one point: these more severe forms require a dermatologist’s evaluation, as they carry a higher risk of scarring if not properly managed.

What Helps, and What Makes It Worse

When dealing with a pimple, no matter what stage it’s in, there are two things you should always do: don’t pop it, and don’t pile on harsh products in the hope of making it go away faster. Gentle cleansing twice a day is enough to prevent follicles from becoming clogged without further irritating skin that’s already inflamed. On the other hand, layering multiple exfoliating or drying ingredients on the same night weakens the skin barrier and can prolong inflammation.

Gentle Purifying Cleanser — VIBRE PARIS

Other, less obvious steps also matter: changing your pillowcase regularly and cleaning surfaces that come into contact with your face helps limit the introduction of additional bacteria. And above all, resist the temptation to try a new product every time you have a breakout: the skin needs several weeks of consistency for a change in routine to produce a noticeable effect. It’s this idea of moderation rather than accumulation that also runs through the article on adult hormonal acne, where the same mechanism of clogged pores follows a cycle-related pattern.

Recognizing the type of pimple you're dealing with doesn't change the need for patience—but it often prevents you from unintentionally making the problem worse.

Sources

• MSD Manual (Consumer Edition) — Acne, Mechanism of Lesion Formation, and General Management
• French Society of Dermatology — Classification of Retentional and Inflammatory Acne Lesions
• French Society of Dermatology — Best Practice Recommendations for the Management of Acne