Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 4/14/2021
Acne can vary massively in severity, from mild comedones to painful, inflamed acne that seems impossible to bring under control.
Inflamed acne develops when bacteria becomes trapped inside clogged pores. As the bacteria multiplies, your skin may become red, swollen and uncomfortable. Sometimes, you may notice several large inflamed acne lesions develop close to each other.
Because it’s so visible, inflamed acne can have a serious effect on both your appearance and your self-confidence.
Luckily, inflamed acne can almost always be treated. In fact, with the right combination of acne medication, self-care and good habits, it’s possible to treat even the most severe inflamed acne breakouts and enjoy clear, blemish-free skin.
Below, we’ve discussed how inflamed acne develops, as well as the symptoms you may notice if you’re prone to inflamed acne breakouts.
We’ve also shared science-based, proven treatment options that you can use to get rid of acne and prevent it from coming back.
Inflamed acne, or inflammatory acne, develops when acne lesions become red, tender and swollen. It can vary in severity from small papules and pustules to severe cystic or nodular acne.
Like other acne, inflamed acne develops when sebum and dead skin cells collect inside your hair follicles and cause them to become clogged.
Not all acne is inflamed. Some mild forms of acne, such as whiteheads and blackheads, typically don’t cause inflammation.
Several medications are available to treat inflamed acne. Some are antibiotics that work by targeting acne-causing bacteria, while others stop acne by reducing sebum levels or stripping away dead skin cells.
If you get very severe or persistent inflamed acne breakouts, you may need to use more than one medication to bring your breakouts under control and clear your skin.
To understand how inflamed acne develops, it’s important to understand the basics of how acne breakouts occur.
All acne, whether it’s inflammatory or non-inflammatory, forms when your hair follicles, or pores, become clogged due to a mix of sebum and dead skin cells.
Sebum is an oily substance that’s secreted by your sebaceous glands. It helps to keep your skin hydrated and provides protection against bacteria, fungi and other pathogens that can infect and damage your skin.
Your skin needs sebum in order to function. However, when your sebaceous glands secrete too much sebum, it can build up inside your hair follicles and cause them to become clogged.
Every day, your skin renews and repairs itself by creating new skin cells to replace old ones. As they’re replaced by new cells, your old, dead skin cells detach from your skin through a process called exfoliation.
Sometimes, dead skin cells don’t exfoliate properly. Just like sebum, these old, leftover cells can build up inside your hair follicles and contribute to blockages.
When a hair follicle is clogged, it becomes an acne lesion. Many acne lesions are comedonal, or non-inflammatory. These are the classic whiteheads and blackheads that you may get near your nose, chin and elsewhere on your face.
Inflamed acne develops when bacteria grows inside a clogged hair follicle. As the bacteria starts to multiply, the wall of the hair follicle may break and the acne lesion may become red, inflamed and tender.
Although all inflamed acne develops through the same basic process, inflamed acne can vary in type and severity. Common types of inflamed acne include:
Papules. These are small raised spots that can form on the surface of your skin. Most papules are red in color and are less than 1cm (approximately 0.4 inches) wide.
Pustules. These are small, pus-filled acne lesions that look similar to blisters. They’re usually found on your face, but can also develop on your body. Pustules may burst or leak when touched, scratched or squeezed.
Nodular acne. Larger inflamed acne lesions are referred to as nodules. These may be tender and painful. Nodular acne develops deeper beneath your skin than other forms of acne and is considered a form of severe acne.
Cystic acne. Cystic acne lesions are fluid-filled acne lesions that develop deep beneath your skin. Like nodular acne, this form of inflamed acne can be painful, tender and tough to get rid of.
When cystic acne occurs with nodular acne, it’s referred to as nodulocystic acne. Both of these forms of severe acne can potentially damage your skin and leave behind acne scarring.
Not all acne becomes inflamed. In some cases, you might develop a mix of inflamed acne and non-inflammatory acne lesions such as blackheads and whiteheads.
At a basic level, inflamed acne is caused by the three factors mentioned above — sebum, dead skin cells and bacteria.
However, behind the scenes, a variety of factors may cause acne breakouts to develop. These include:
Hormones. Certain hormones control your skin’s production of sebum. As your levels of these hormones fluctuate, you might be more at risk of developing acne lesions that can become infected and inflamed.
A variety of factors can affect your hormone levels, including your menstrual cycle, use of hormonal birth control, pregnancy and menopause. We’ve talked about these more in our guide to hormonal acne.
Endocrine diseases. Diseases that affect your production of certain hormones, such as polycystic ovary syndrome (PCOS) may cause you to develop acne.
Genetics. Your genes may play a role in your risk of developing acne. For example, you may inherit a risk of developing acne breakouts from your parents.
Medications. Certain medications, such as anticonvulsants, lithium, steroids and others, may increase your risk of developing acne.
Smoking. Although smoking doesn’t appear to cause inflamed acne specifically, there is a link between smoking and your chance of developing acne.
Our guide to the causes of acne goes into more detail about the factors that may affect your risk of developing acne breakouts.
Inflamed acne can cause a range of symptoms. You may notice small papules or pustules that develop in certain parts of your face, or severe, persistent breakouts of cystic acne that may be difficult to treat.
Common symptoms of inflamed acne include:
Red, swollen acne lesions
Tenderness, pain and discomfort
Lesions that contain fluid and/or pus
When inflamed acne is severe, it can also cause psychological symptoms, such as depression and/or low self-esteem.
Inflamed acne can also cause scarring and dark spots that may affect your skin’s appearance after your acne breakouts clear.
Inflamed acne is treatable. Even if your breakouts are severe and persistent, it’s almost always possible to bring inflamed acne under control with the right combination of science-based acne treatments and changes to your skin care habits.
If you have mild to moderate inflamed acne, you may be able to control your breakouts using a combination of over-the-counter skin care products. These include:
Facial cleanser. A gentle, non-abrasive cleanser will help to wash away dead skin cells and excess sebum that can clog your pores and cause breakouts.
Benzoyl peroxide. Benzoyl peroxide is a popular over-the-counter acne ingredient that works by stopping the growth of acne-causing bacteria. You can find benzoyl peroxide in many over-the-counter acne creams, gels and cleansers.
Over-the-counter retinoids. Retinoids, medications derived from vitamin A, are widely used to treat acne. You can find mild retinoids such as retinol and adapalene in creams, gels and other products for treating acne available over the counter.
Several prescription medications are available for inflamed acne. These are worth considering if your acne is moderate to severe in nature and doesn’t seem to disappear with over-the-counter treatments.
Common prescription medications for inflamed acne include:
Tretinoin. Tretinoin is a topical retinoid that’s used to treat acne breakouts. It works by speeding up your skin’s turnover of new cells and stopping the hair follicles in your skin from becoming clogged.
Tretinoin is available as a prescription cream or gel. It’s also one of several ingredients in our Customized Rx Acne Cream, which is tailored to treat your specific acne needs.
Clindamycin. Clindamycin is a topical antibiotic. It works by preventing the bacteria that cause inflamed acne from growing on your skin. It also helps to decrease swelling that often occurs during inflamed acne breakouts.
Like tretinoin, clindamycin is available as a topical cream, gel or as an active ingredient in our Customized Rx Acne Cream.
Hormonal birth control. Several forms of the combination birth control pill are available to treat acne. These work by changing your hormone levels to reduce your production of sebum and stop your hair follicles from becoming clogged.
Currently, the FDA has approved three birth control pills as treatments for acne. You can learn more about using these medications for inflamed acne in our guide to birth control and acne.
Isotretinoin. Isotretinoin is an oral prescription medication for acne. It’s highly effective at getting rid of inflamed acne, but can cause side effects such as cracked lips and dry, peeling skin, particularly during the first few weeks or months of treatment.
If you’re prescribed isotretinoin, you’ll need to check in with your healthcare provider on a regular basis. You’ll also need to use more than one form of birth control while using this medication, as isotretinoin isn’t safe for use during pregnancy.
Getting rid of your existing breakouts is the first step in treating inflamed acne. After you’ve done this, it’s equally important to make changes to your skin care habits and lifestyle to prevent your inflamed acne from coming back. Make sure to:
Use your medication exactly as prescribed. It’s important to use your medication for as long as your healthcare provider recommends, even if your acne begins to clear up after a few days or weeks.
Bacteria can multiply very quickly, and stopping treatment early may increase your risk of dealing with recurring inflamed acne breakouts in the future.
Wash your face twice a day, plus after exercise. This helps to wash away sweat and bacteria that can cause acne breakouts or worsen acne. Try to wash your face twice a day, as well as after you exercise or do anything else that causes you to sweat.
When you wash your face, use a mild, non-comedogenic cleanser and gently apply it to your skin. Avoid washing too frequently or scrubbing your skin firmly, as these can both worsen your acne breakouts.
Try not to touch your face. This may trigger acne flare-ups and transfer bacteria from your hands to your face. If you need to touch your face, make sure that you wash your hands thoroughly using soap and water beforehand.
When you notice acne, treat it early. The sooner you take action and treat your acne breakouts, the lower your risk of dealing with severe or persistent breakouts, scars and dark spots called post-inflammatory hyperpigmentation (PIH).
Use non-comedogenic makeup and skin care products. Look for makeup and skin care products that are labeled “non-comedogenic” or “oil-free.” These are less likely to clog your pores and trigger acne breakouts.
Make sure to avoid skin care products that contain alcohol, artificial fragrances or other substances that may cause irritation and inflammation.
Regardless of the type of makeup you use, make sure to carefully remove your makeup before you go to bed.
Avoid popping your pimples. If you develop acne, avoid popping it yourself. Although it may feel good to pop a pimple, doing this can transfer bacteria from your fingers onto your face, increasing your risk of developing an infection.
Popping your pimples can also worsen your existing breakouts and increase your risk of developing acne scarring.
If you have inflamed acne that you think needs urgent attention, contact a dermatologist for help. They’ll be able to extract the acne with sterile equipment or use a corticosteroid to safely shrink and flatten the acne.
If you still notice inflamed acne even after using medication and making changes to your habits, it’s important to talk to your healthcare provider.
Inflamed acne can be stressful to deal with, especially if you’re prone to random breakouts that seem to come at the worst possible times.
However, even the most severe inflamed acne is usually treatable with the right combination of skin care products, acne medication and self-care.
To get started treating acne, you can view our range of prescription acne treatments and talk to a licensed healthcare provider online. If appropriate, you’ll receive a prescription for medication to control your acne and prevent your breakouts from coming back.