Acne Papules: Causes, Treatments, Natural Remedies, Do’s and Don’ts

• Acne papules are a symptom of inflammatory acne
• They result from an accumulation of sebum, debris and bacteria trapped within skin cells
• Treatment includes over-the counter and prescription options, and home remedies to help ease inflammation and irritation

Acne is a very common skin disease that is seen in both adolescents and adults, and is either classified as noninflammatory or inflammatory. Acne papules are lesions that fall within the latter category and can develop in mild, moderate or severe cases. 

What Are Papules?

Acne develops when excess sebum (oil), dead skin cells and debris accumulate in pores. This matter forms microcomedones, comedones that are so small they are undetectable. These lesions are the precursors to any type of acne lesion. 

With time, microcomedones increase in size as additional material becomes trapped and Cutibacterium acnes bacteria multiply. Pressure builds up within hair follicles putting pressure on the follicular walls, which rupture and spread into the surrounding tissue.  

This results in the development of papules, small, red pumps accompanied by redness, inflammation and irritation. These appear on the surface of skin, are firm to the touch and do not contain pus.

Papules, like other acne lesions are likely to develop on the face, back, chest and shoulders, as these areas have the most oil-producing sebaceous glands. 

Papules vs. pustules

With the spread of infected material to the surrounding areas, the inflammation increases and the immune system responds by sending white cells to kill the bacteria. This results in small, blister-like bumps, called pustules. These contain pus – an accumulation of body fluids, dead white cells and germs.

Pustules are inflamed, tender and can be painful. This tip of the bump will be white or yellow in color which is evidence of this pus. In comparison, papules are firm and red, and do not have inflammation and pus.

Papules vs. nodules

Nodules are painful, solid knots that form deep with skin tissue and can be seen as red bumps on the skin’s surface. Nodules are considered a severe form of acne; without treatment they can cause widespread damage to tissue and skin, and significant scarring. 

In contrast, papules develop near the surface of skin, are smaller, milder lesions with far less pain and inflammation. 

What Causes Acne Papules?

Acne papules form when microcomedones develop into microcomedones and are not treated. This blockage traps more oils which creates a favorable environment for C. acnes to flourish resulting in papules.

Many factors have been identified as contributing to acne formation; all of these are linked to increased sebum production. In addition, a poor skin care routine can also contribute to breakouts.  

Hormones

Sex hormones, especially androgens (the male sex hormones), play a significant role in the formation of papules and other acne lesions. Not only do androgens promote the production of sebum, they also regulate the body’s inflammatory response to acne.

Stress

Emotional stress, anxiety and fear are not known to cause acne but to exacerbate symptoms and trigger breakouts. 

While the exact mechanism responsible for this is unknown, corticotropin-releasing hormone (CRH), a key hormone in the stress response, is understood to stimulate the production of sebum. 

In one study, researchers demonstrated that the higher the stress level, the more severe the acne.

Skin care routine

Lack of an effective skin routine can lead to a buildup of oils, grime and dead skin cells on the skin’s surface. Using products that are not compatible with your skin type, are too harsh or comedogenic can damage the skin barrier, opening the door to skin conditions such as acne. 

Overwashing or using alcohol-based products can also trigger oil production in skin and worsen acne. 

Diet

Although more research is needed to officially confirm this theory, diet is often cited as a cause of pimple breakouts. This includes eating a diet high in sugar and dietary fat, certain food groups (such as dairy), and even singular food items. Chocolate is one such food item that is often singled out as a cause of acne.

There is clinical evidence to support that both dairy and chocolate can exacerbate acne, as well as an overall high glycemic diet. Foods with high glycemic indexes include white rice, white bread and potatoes.

How Are Acne Papules Treated?

Although acne papules do not produce scarring and resolve on their own over time, many people may find them both visibly and tactilely irritating. 

In order to reduce their appearance and speed up recovery time, there are a variety of topical treatments for consideration and other treatment options for more severe cases.

Topical treatments

Topical acne treatments are the most common way to treat papules. These include over-the-counter (OTC) acne products such as glycolic acid, salicylic acid (SA) and benzoyl peroxide, which can be found in a range of creams, cleansers and masks. 

Glycolic acid, SA and benzoyl peroxide remove excess oil and skin cells from the skin. This can help to clear existing papules, and also prevents the formation of new ones.

One study saw a significant improvement in those with mild acne after using a topical glycolic acid treatment.

When you first start using these medications, your skin might feel overly dry or irritated. This is because hydroxy acid products tend to have a low pH, and their acidity can disrupt the epidermal barrier. 

The epidermal barrier, also called the skin’s natural barrier, protects the skin against bacteria and photodamage, and keeps it moisturized. Therefore, when compromised, skin is more likely to dry out and feel irritated. 

For more severe cases of inflammatory acne, your doctor might prescribe retinoids, such as tretinoin (Retin-A), or antibiotics, such as dapsone (Aczone). Retinoids fight against the root cause of papules—clogged pores—but also help to reduce inflammation. Topical antibiotics work by killing off acne-related skin bacteria.

Other treatments

Alternative treatments for papules consist primarily of oral medications. These include oral antibiotics, such as erythromycin, and various hormonal agents. For women, both oral contraceptives and antiandrogens can help reduce acne under some circumstances.

Natural Remedies for Acne Papules

There are very few home remedies which specifically target papules. Instead, a number of general acne remedies are reported to help treat and prevent lesions and pimples by cleaning away excess oil and skin cells, killing bacteria and reducing inflammation.

Apple cider vinegar

Method: Mix equal parts water and apple cider vinegar and dab the mixture onto pimples with a cotton swab or ball.

Logic: Apple cider vinegar contains organic acids which kill off bacteria, therefore it reduces the presence of acne-causing bacteria. 

Lemon juice

Method: Cut a wedge of lemon and gently press it against your pimples.

Logic: Lemon juice contains citric acid. Just like with apple cider vinegar, these acidic properties may be able to kill the bacteria associated with acne. However, some warn that lemon juice is too acidic for the skin, and may do more harm than good.

Green tea

Method: Steep 1  tea bag in hot water for several minutes, then cool; apply the tea bag directly to your pimples.

Logic: Green tea is said to fight off bacteria. It has also been shown to reduce inflammation, so it may help with soothing existing lesions.

Honey

Method: Dab a small amount of honey onto your pimples.

Logic: Honey is a natural antibacterial. This means it may be able to reduce the bacteria that contribute to acne.

Ice

Method: Wrap an ice cube in a clean cloth and hold it gently against your pimples for a few  seconds at a time.

Logic: Ice helps to soothe inflammation. Although it won’t prevent lesions from forming, it may be able to reduce redness and swelling.

Acne Papules Prevention Do’s and Don’ts

Preventative measures can go a long way to discourage the formation of papules. Use your skin care products consistently, maintain hygiene and follow a proper diet. Here are some guidelines for prevention:

Do’s:

• Use glycolic acid, SA or benzoyl peroxide. Although they may be irritating in high concentrations, face washes and other products containing these ingredients in a low concentration are safe treatments for pimples of all kinds. 
• Use the remedies that work for you. Individuals will see different results depending on the remedy they choose; it is important to assess your options and target your specific needs.
• Consult a dermatologist. For treating more severe acne with a large number of papules, it is best to consult a dermatologist in search of stronger medications, such as dapsone. 

Don’ts:

• Pop your pimples. Not only does picking at your skin help spread bacteria; it makes it harder for pimples to heal and may even cause scarring.
• Eat foods that cause acne. If you have noticed that certain food groups, especially high glycemic foods, or food items seem to worsen your acne, limit consumption or avoid them altogether.

Takeaway

Acne papules are inflammatory pimples that are not to be confused with pustules which contain pus. Papules occur when pimples remain untreated, and the pressure built up inside the closed comedone inflames and irritates surrounding skin. This can be caused by genetics, as well as external factors such as stress or diet. 

Treatments for papules coincide with general acne treatments, with a focus on antibacterial and anti-inflammatory ingredients. In most cases of acne, OTC topical products—especially cleansers containing hydroxy acids—are the most widely studied and used. 

Some at-home remedies may also be viable options for those who have mild to moderate acne. If your acne is severe, or if hormones are the identifiable cause, talk to your doctor about oral contraceptives as a possible treatment.

Although it may be tempting to pick at pimples and papules, it should be avoided. Doing this, as well as using overly abrasive products, will only irritate skin further, leading to increased inflammation and possibly scarring.