Pimples on Your Face: How to Recognize Them by Type and Location

• Pimples or acne: pimples on your face are not always acne; other skin conditions closely resemble it.
• Type: open or closed comedones stay on the surface; papules and pustules form raised pimples. Nodules and cysts are deeper, can be painful and can leave scars.
• Location: the forehead, cheeks, chin, the area around the mouth or a shaved area give clues worth noting, never a definite cause.
• Before the assessment: note how long the pimples have been there, where they appear and what you feel. Mention any recent products and medications, shaving and, if it applies to you, your menstrual cycle.
• When to see a doctor: seek medical advice if the pimples are numerous, deep or painful, leave scars, do not improve despite skin care or treatment, or affect your mood. Do not wait if the skin becomes warm, painful and swollen.

While removing your makeup or shaving, you feel a small bump on your cheek under your fingertip, then another one near your mouth. Before buying a product, you want to know what it is. Pimples on your face are not always acne: other skin conditions closely resemble it. What they look like, how they change over time, what you feel and where they are help describe them; it takes an examination to find out what they are.

A clogged pore, a pus-filled pimple and a bump under the skin are not described in the same way. Each name helps you describe more precisely what you see, without making a diagnosis yourself.

On the surface: comedones. Blackheads are open comedones: the clogged pore stays open at the surface. A whitehead is a closed comedone. It forms a small whitish bump because sebum, the skin’s oil, and keratin, a protein in the skin, build up in a pore that has stayed closed. It is sometimes called a microcyst, but it stays on the surface, unlike a deep cyst.

Raised: papules and pustules. A papule is a raised pimple without pus, sometimes painful. Pink or red on white skin, it can look brown or purplish on brown or Black skin. So do not rely on redness alone to describe your pimples. A pustule is a raised pimple that contains pus.

Under the skin: nodules and cysts. A nodule is a deep bump that can be painful, sometimes with no visible redness on the surface; it can rupture and leave a scar. A cyst also sits deep under the skin and contains pus. Nodules and cysts form larger bumps, which can merge. Pain is possible, but its absence is not enough to rule out a deep lesion.

So a whitehead is not a small version of a deep bump: one stays on the surface; the other sits under the skin, can be painful and can leave a scar. Even with these guidelines, you cannot reliably tell a nodule from a cyst or know the cause of the breakout without an examination.

These lesions can be part of acne. To describe your type of acne, specify whether you see clogged pores, papules, pustules or deep bumps. Papules and pustules also appear in other conditions that resemble acne. If you see only blackheads, describe these open pores; mention any deep or painful bump separately.

Location alone does not tell you the cause of your pimples, nor does it show that an organ is involved. Instead, it helps identify what comes into contact with the skin in that area: a hair product near the forehead or shaving along the jaw, for example.

Pimples on the Forehead and Along the Hairline

Whiteheads and small skin-coloured bumps along the hairline, on the forehead or on the back of the neck can come from a hair product. When the product contains oil, the oil can reach the skin, clog pores and contribute to pimples. This applies to men as well as women: an oily styling product can also reach the forehead.

If you have recently changed products, note the date of the change, the date the pimples appeared and the areas affected. This timeline gives a clue; it does not prove that the product explains all your pimples.

Pimples on the Cheeks

On the cheeks, also look at what surrounds the pimples. Redness in the centre of the face that comes and goes or persists, on very sensitive skin that stings or burns, can occur with rosacea: some forms of it cause pimples that closely resemble acne. Note whether the redness persists between flare-ups and what you feel. These details help make the distinction during the examination; the cheek alone is not enough to do so.

On the Chin and Jaw

In some women, pimples that keep coming back on the lower face, along the jaw and on the neck despite the skin care or treatments already tried can lead a doctor to discuss a hormonal approach. But their location does not prove that a hormonal cause is involved: the doctor first examines the skin and asks you questions about your health.

If you have periods, note whether flare-ups follow your menstrual cycle. Also mention increased hair growth or irregular periods, especially if the acne started in adulthood.

If you are a man, describe what the pimples on your jaw look like, how they change over time and the sensations they cause. If they are in the shaved area, also mention how you shave and when they appear in relation to shaving.

Around the Mouth

What looks like acne near the mouth is not always acne. A rash of many small pimples confined to the area around the mouth can be perioral dermatitis. The skin can burn or itch. Without treatment, this rash can last for months or even years: that is a good reason to have it identified rather than trying one anti-pimple product after another.

After Shaving

In a shaved area, folliculitis and ingrown hairs can both cause pimples, but not for the same reason. Folliculitis can be an infection that develops in the follicles, where hairs grow. It often looks like a sudden acne breakout; it can itch, hurt or cause no particular sensation. Razor bumps, on the other hand, come from hairs cut short that curl back into the skin, especially when they are thick and curly. The skin then reacts to these ingrown hairs.

The link with shaving is not enough to establish which of these situations is involved, or to rule out acne. Note when the pimples appear after shaving, where they are and what you feel: an examination helps determine whether it is folliculitis or another condition that resembles it.

A sudden breakout can look like acne without being acne. The colour of pimples also varies with skin tone, and pimples in the same spot can have different causes. So note how they change over time and what you feel, in addition to what they look like.

None of these clues is enough on its own to settle the question: it takes an examination to find out whether your pimples are acne or a condition that resembles it.

You do not have to name what you have yourself: describing it is enough. Before the assessment, note:

• how long the pimples have been there, whether they come back in the same places and how they change over time;
• what they look like: comedones, raised pimples, pus-filled pimples, deep bumps;
• what you feel: pain, itching, burning, stinging;
• any redness, and whether it persists between flare-ups;
• the products you use on your skin and hair, and any recent change;
• any link with shaving, if you shave;
• if it applies to you, your menstrual cycle, increased hair growth or irregular periods;
• your medications, supplements and natural health products, especially any you started recently;
• any skin care or treatments you have already tried and how well your skin tolerated them.

Some medications can trigger an acne flare-up. If you suspect yours, do not stop taking it on your own: talk to the person who prescribed it.

Seek a doctor’s advice if your pimples do not improve despite the skin care or treatments you have tried, if they are numerous, deep or painful, if they leave scars, or if they affect your mood. Also mention acne that started in adulthood together with increased hair growth or irregular periods, or pimples that appeared after you started a new medication.

A darker mark that remains after a pimple is not necessarily a new pimple: this type of mark can appear after irritation or an injury to the skin. Mention it too, without confusing it with a flare-up.

A bump on the eyelid calls for an eye examination by a doctor.