Inflammatory Acne: Types, OTC Treatments, Natural Remedies and More

• Inflammatory acne develops when debris, dead skin cells and bacteria become trapped within pores
• This causes papules and pustules to form and for more serious cases, cysts and nodules, which develop deep within tissue 
• Accompanying symptoms include redness, swelling, itching, tenderness or pain
• Effective treatments are available in over-the-counter and natural products, and prescription-strength medication

Acne is a very common chronic skin disease that is categorized as inflammatory or noninflammatory. Noninflammatory acne presents with whiteheads and blackheads (comedones) which occur due to clogged pores; inflammatory acne describes pustules, cysts and nodules that develop when bacteria proliferates, causing redness, swelling and pain. 

What Is Inflammatory Acne? 

Inflammatory acne begins with the formation of comedones; these are small plugs of trapped dead skin cells and sebum that congest pores.  

With time, Cutibacterium acnes trapped within these pores begin to flourish. This adds pressure to the pore walls, which eventually breaks down and releases the infection to the surrounding tissue.

In response to this perceived threat, your immune system sends white blood cells to flood the area and fight the infection. It’s this response that causes worsening symptoms in the form of pus-filled papules and pustules, redness, swelling and tenderness that typically accompanies inflammatory acne. 

Cysts are large pus-filled lesions that rest deep within the skin’s surface; nodules are large, hard, inflamed masses that can cause extensive tissue damage and scarring. Both are severe forms of inflammatory acne.

While these lesions are most common on the face, they also develop on the neck, torso, shoulders and back; this is due to the greater presence of sebaceous glands in these areas. Sebum is a strong driver of acne development. 

Inflammatory vs. noninflammatory acne

Noninflammatory acne refers to blackheads and whiteheads – excess oil, debris and dead skin cells that combine to form hard plugs in pores. These are not inflamed and so do not cause any discomfort.

Inflammatory acne develops when bacteria proliferates. Red pus-filled bumps develop and cause swelling, tenderness and pain. This infection can spread, worsen and cause scarring if left untreated. 

Types of Inflammatory Acne Lesions

There are several types of inflammatory acne lesions, listed below from mild to severe.

Inflammatory acne progression
Papules	Develop once comedones break down due to the presence of bacteria. These spread and then form small, red, pus-free bumps on the surface of skin
Pustules	Similar to blisters and larger than papules, these lesions are surrounded by a red ring of inflammation; lesions are filled with pus
Cysts	Large lesions that form deep within tissue and appear as boils on the skin’s surface Can cause pain and extensive scarring
Nodules	Form deep within the skin but can be seen as red bumps on the surface Painful, hard masses that can cause severe tissue damage and scarring Solid masses that do not release pus

Best Over-the-Counter Treatments for Inflammatory Acne

Over-the-counter (OTC) solutions are the first step in treating acne. There are several treatments available to target and kill C. acnes, calm inflammation, and clear pores of oils and debris.

Adapalene

Adapalene 0.1% gel is a retinoid and is FDA-approved as an OTC treatment for acne. Retinoids are considered first-line therapy as they can treat acne through several mechanisms of action.

Adapalene has been demonstrated to exfoliate and reduce the appearance of existing lesions, calm inflammation and irritation, and regulate skin cell turnover to prevent pimples from forming. 

Retinoids are typically paired with benzoyl peroxide to achieve greater results.

Azelaic acid 

Azelaic acid is a natural substance that can inhibit comedone formation and therefore reduce the risk of inflammatory acne developing. It can target multiple causes of acne as it is an antibacterial and has profound anti-inflammatory and antioxidative effects.  

These properties serve to kill bacteria and reduce inflammation, and promote cell turnover to promote skin healing. Lastly, azelaic acid can help lighten postinflammatory hyperpigmentation (PIH), the dark marks that can remain once acne clears.

You can find a range of skin care products including serums, gels, peels in various strengths up to 10%. 

Benzoyl peroxide

Benzoyl peroxide is a first-line therapy for inflammatory acne as it can effectively kill bacteria, unclog pores and reduce inflammation. It can be used as a sole treatment but is commonly combined with one or two other therapies for greater results.

This compound also plays an important role in antibiotic resistance, which is an ongoing and growing health concern. Benzoyl peroxide works rapidly on C. acnes without causing antibiotic resistance. As a bactericidal agent; combining it with a topical antibiotic has been proven to reduce bacteria count by 99.7% after 1 week of therapy. 

Sold in strengths of 5%–10%, it’s available in a range of cleansers, gels, lotions and creams.

Salicylic acid 

Salicylic acid, a beta-hydroxy acid, is a chemical exfoliant that loosens the bonds that hold dead skin cells together on the surface of skin. This sloughs off these unwanted cells along with pore-clogging oil and debris. This acid also works to suppress inflammation, calm redness and dry up lesions.

With regular use, salicylic acid will clear pores and help prevent further breakouts. It can be found in cleansers, lotions and treatment pads in 0.5%–2.0% strengths.

Best Prescription Treatments for Inflammatory Acne

If OTC treatments prove ineffective in improving your acne, it’s important to see your dermatologist to quickly begin a prescription treatment plan. 

Doing so will allow you to gain control of your acne symptoms and minimize the risk of scarring. These treatments are regularly used in combination for greater results.

Systemic treatments

For severe or treatment-resistant acne, oral antibiotics such as doxycycline, minocycline, and erythromycin are prescribed. 

As well, hormonal therapies in the form of oral contraceptives are prescribed for women who also need birth control. Isotretinoin and spironolactone are also effective; the latter has been demonstrated to provide dramatic improvements in symptoms.

Topical retinoids

As with benzoyl peroxide, topical retinoids are considered a mainstay of acne treatment; they exfoliate the skin, unclog pores and prevent papules and pustules from forming. 

Derived from synthetic vitamin A, retinoids include first-generation tretinoin, second generation etretinate and acitretin (for psoriasis), and third generation adapalene and tazarotene. While effective, these are known to cause a number of side effects.

Fourth-generation FDA-approved trifarotene is the latest retinoid to be added to the acne treatment arsenal and is the first retinoid approved for both facial and truncal acne.

Compared to the older generations of retinoids, trifarotene has demonstrated excellent tolerability and safety, and is considered a game-changer in acne treatment.

Topical combination medications

Topical combination therapies are typically chosen to avoid skin sensitization and antibiotic resistance. Importantly, agents with different modes of action have been shown to provide better outcomes than monotherapy. 

Your dermatologist will prescribe a combination therapy that takes into account your medication history and one that best addresses your acne symptoms. Therapy typically consists of a combination of several medications that may include antibiotics, retinoids, benzoyl peroxide, azelaic or salicylic acid or combinations of topicals.

Natural Treatments for Inflammatory Acne

Natural treatments can be incorporated within your treatment regimen to reduce the itching, swelling and tenderness that accompanies acne flare-ups.  

Aloe vera

Aloe vera has antioxidant, antibacterial and anti-inflammatory qualities; it has been demonstrated to speed up the regeneration of damaged skin and to significantly reduce acne lesions. 

Aloe vera has humectants which work to bind moisture to the skin, and acne treatments are known to dry skin which can cause redness and irritation. The moisturizing properties of aloe vera not only smooth and soften skin but can help stimulate collagen and elastin production to strengthen tissue.

Honey and purified bee venom

An ancient remedy for a wide range of skin conditions, honey contains antioxidant, antiseptic and antibacterial properties. These all work together to clear pores of grime, debris and bacteria, and to hydrate and soften skin. Honey also has strong wound healing activity. 

In vivo tests have shown that purified bee venom also contains antibacterial properties to kill acne-causing bacteria. 

Tea tree oil

Tea tree oil is an essential oil that is prized for its many skin healing and enriching benefits. It has antibacterial, antifungal, antimicrobial and antioxidant properties to target bacteria, inflammation and irritation, and to speed up wound healing. 

One study demonstrated that tea tree oil effectively reduced the lesion count of mild-to-moderate acne and was well tolerated.

Jojoba oil

Jojoba oil is another essential oil that has a number of strong properties to heal acne. As an antioxidant, anti-acne, anti-inflammatory, antifungal, antimicrobial and an analgesic means it can help calm discomfort and enhance healing. It also balances oil production, hydrates and protects skin.

Jojoba oil has a high effectiveness in treating acne and is well tolerated. This efficacy indicates that jojoba oil may be used alone or in addition to other treatments. 

When to See a Doctor

If you don’t see an improvement with OTC  treatments or if your symptoms worsen, you should see your dermatologist to control symptoms and to start a personalized treatment plan. Doing so will minimize skin damage and help prevent scarring. 

Takeaway

Inflammatory acne develops when C. acnes becomes trapped within pores along with oils, debris and dead skin cells. This causes an infection which manifests as papules, and with time, will degrade to pus-filled pustules surrounded by red, inflamed skin.

Several effective OTC products are available to treat and prevent inflammatory lesions. These include salicylic acid, benzoyl peroxide and topical retinoids. 

For moderate to severe acne, or for acne that doesn’t respond to conventional treatments, systemic solutions such as antibiotics and oral contraceptives have been shown to be effective.

Lastly, natural treatments such as aloe vera and tea tree and jojoba essential oils have been demonstrated to heal inflammatory acne lesions, calm redness and irritation, and hydrate and protect skin.