- Inflammatory acne is caused by an immune response to clogged pores and P. acnes, the bacteria that can cause acne.
- Sufferers can experience redness, swelling, pain, papules, pustules, lesions and cysts deep beneath the skin, depending on the severity of the breakout.
- There is a wide range of effective treatments, from natural remedies to over-the-counter products.
- However, if your breakout is severe or cystic, it’s best to see your dermatologist for a more targeted, fast-acting prescription treatment.
All forms of acne feature clogged pores. However, the underlying cause of those clogged pores – whether it’s inflammatory and non-inflammatory – will determine how you treat your symptoms.
Of the two, inflammatory acne is the most frustrating, because, in addition to blackheads and whiteheads, you’ll also experience pustules, redness, swelling, pain and more extensive lesions. Read on to learn more about the differences between inflammatory and non-inflammatory acne and what you can do about it.
What Is Inflammatory Acne?
Like non-inflammatory or comedonal acne, inflammatory acne begins with small pore blockages or plugs, called micromedos that prevent pores from opening and clearing out trapped oil and dirt.
As an inflammatory breakout develops, more and more oil flows into your pores, allowing acne-causing bacteria (sometimes including Propionibacterium acnes or P. acnes) to flourish beneath the plug. This adds pressure to the pore, which eventually breaks down and releases bacteria into the surrounding skin.
In an attempt to stem this invasion of bacteria, your immune system sends white blood cells to flood the area and fight the potential infection. It’s this immune response that causes the redness, swelling and pain usually associated with inflammatory acne.
Inflammatory vs non-inflammatory acne
Determining whether you’re experiencing a non-inflammatory or inflammatory breakout depends on the severity of the inflammation. Non-inflammatory blemishes typically remain closer to your skin’s surface.
A diagnosis of inflammatory acne always accompanies pores that are infected by bacteria. Initially, you’ll probably see the usual red blemishes (papules, or pimples that don’t contain pus) and whiteheads (pustules, or pimples that contain pus).
However, as your breakout worsens, nodules and cysts can form deep beneath your skin, which becomes increasingly red and swollen. These are more likely to scar or cause post-inflammatory hyperpigmentation after the lesions heal, so it’s vital to start treating a bout of inflammatory acne as soon as possible.
Types of Inflammatory Acne
To complicate matters, there are also several inflammatory acne types, each requiring a different form of treatment. These include:
- Inflamed comedones that feature visibly swollen blackheads and whiteheads.
- Papules, or small red bumps on the surface of your skin.
- Pustules, or larger blemishes filled with pus.
- Nodules, or pus-filled bumps occurring deeper beneath your skin’s surface.
- Cysts, or large pus-filled nodules that are painful to the touch.
Best OTC and Prescription Treatments for Inflammatory Acne
If you’re experiencing a mild bout of inflammatory acne, over-the-counter treatments can help. They primarily aim to reduce the dead skin cell build-up, oil and acne-causing bacteria before they become inflamed. The most effective products contain salicylic acid or benzoyl peroxide – use them as directed over some weeks then gauge how your acne responds.
If over-the-counter treatments prove ineffective in clearing up your breakout, prescription medicine is necessary – the higher risk of scarring with moderate to severe inflammatory acne means you’ll want to get on to treatment fast.
Below is a list of the most common over-the-counter and prescription treatments, how to use them, and how they work to combat your inflamed breakout.
Salicylic acid helps keep your pores clear by shedding dead skin cells more efficiently. It’s found in conventional over-the-counter cleansers, lotions and treatment pads in .5 to 2% strengths. Consider using it if your inflammatory acne is at an initial stage because it will work to prevent further breakouts.
A typical over-the-counter acne treatment, benzoyl peroxide kills p. acnes bacteria, unclogs your pores and reduces inflammation. Sold in strengths from 2.5% to 10%, you’ll find it in a range of creams, gels, cleansers and lotions.
Alcohol and Acetone
The combination of alcohol and acetone are common in over-the-counter products targeting oily skin, such as toners, cleansers and astringents.
- Acetone removes excess oil to reduce the incidence of clogged pores.
- Alcohol is antimicrobial and may work to decrease acne-causing bacteria, diminishing the need for an immune response.
Your dermatologist may prescribe a cream, foam or gel containing azelaic acid if you have mild to moderate inflammatory acne. Azelaic acid balances your skin’s ability to shed dead skin cells, unclogs pores, decreases inflammation, reduces P .acnes and can improve post-inflammatory hyperpigmentation.
However, studies suggest those with sensitive skin should use azelaic acid with caution because side effects can include redness, irritation and burning sensations. It’s also unknown whether it’s safe to use when pregnant.
Popular and significantly effective for treating inflammatory acne, over-the-counter and prescribed topical retinoids exfoliate your skin, unclog pores and help prevent papules and pustules from forming.
Derived from synthetic vitamin A, the most commonly used topical retinoids are tretinoin, tazarotene and adapalene. They each have the added benefit of being an excellent anti-aging treatment.
Topical Combination Medications
Topical combination therapies can help avoid skin sensitization, antibiotic resistance and enhance the treatment outcomes. These kill acne-causing bacteria, unclog your pores and normalize the shedding of dead skin cells. Because they contain two acne-fighting ingredients, you can use fewer antibiotics to kill bacteria when compared to topical antibiotics alone.
Your dermatologist will prescribe the combination therapy that best suits the severity and symptoms of your inflammatory acne. Common combinations usually include clindamycin, benzoyl peroxide, erythromycin, adapalene and tretinoin.
Natural Treatments for Inflammatory Acne
Natural and herbal treatments have been used for centuries to help with a range of inflammatory skin problems. You might like to try the following to see if they work for you:
Tea tree oil
A natural antibacterial and anti-inflammatory, a 2015 review study demonstrated that tea tree oil could work as well as 5% benzoyl peroxide to reduce swelling, redness and kill p. acnes in those mild to moderate acne.
Extracted from Jojoba seeds, a 2012 study reported a 54% improvement in acne for those using a jojoba oil face mask, including reduced skin inflammation, redness, swelling, whiteheads and lesion healing.
Naturally antibacterial and anti-inflammatory, aloe vera may reduce acne appearance and prevent breakouts. It’s great for those who experience dry skin after using other acne-fighting products. When combined with tretinoin cream, researchers reported a significant improvement in inflammatory acne within 8 weeks compared to those using tretinoin gel alone.
Honey and Purified Bee Venom
An ancient remedy for all kinds of skin conditions, honey contains antioxidants and antibacterial properties that can help unclog pores and speed up wound healing. Purified bee venom also contains antibacterial properties that can destroy P. acnes bacteria, according to these 2013 and 2016 studies.
Traditional medicine swears by garlic to combat infections and boost the immune system. It contains organosulfur, a natural antibacterial and anti-inflammatory. However, you’ll want to check whether directly applying it to your blemishes irritate your skin.
Famously high in polyphenol antioxidants called catechins, green tea is thought to reduce skin inflammation. It’s worth trying to see if it works for you, particularly if your skin also produces too much sebum and you suspect P.acnes may be present. One study even found an 89% reduction in whiteheads after just 8 weeks of using green tea extract.
A 2013 research report suggested rosemary extract applied to blemishes might reduce inflammation caused by P. acnes as well as delivering other antioxidant and antibacterial benefits.
Another natural remedy containing anti-inflammatory and antibacterial properties, topical use of coconut oil may destroy P. acnes, decrease redness and swelling, and speed up wound healing.
When to See a Doctor
Whether you try over-the-counter or natural topical treatments, if your initial efforts to control your inflammatory acne aren’t working, call your dermatologist. Any painful acne blemishes should be examined by a medical professional as soon as possible. It’s vitally important you don’t let your breakout evolve into cystic acne because of the risk of scarring. Your skin specialist can prescribe the right treatment to tame your breakout fast.
Inflammatory acne can be painful, disfiguring and embarrassing. Still, there is a range of products available from natural remedies to dermatologist-prescribe treatments that can soothe, clear and bring it back under control faster. Don’t wait until your condition becomes severe – if left unchecked, the inflammation and infection can worsen and cause significant scarring.
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