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5 Stages of Common Acne and How to Treat It

Finding a long-lasting solution for stubborn acne and persistent breakouts can be tricky. There are so many treatment options available out there, all of them claiming to be effective.

You’ve probably tried one or more of these miracle cures at some point. But which of those treatments actually work?

Don’t worry! In this article, we’ll help you identify the 5 stages of common acne you might suffer from, and the recommended treatment for each stage.

Acne is actually a very broad term for a series of skin ailments. So in this article, we’ll be focusing on acne vulgaris,

the most common type of acne.

Here’s a fun fact: the word vulgaris means ‘common’ in Latin. 

This type of acne is what plagues the faces of adolescents during puberty but it can also affect adults. 

The 5 Stages of Acne Vulgaris


Blackheads are formed when dead skin cells, bacteria and sebum get trapped at the opening of pores. Because they are exposed to the air, they turn black due to oxidation.

Recommended treatment options: 

  1. Extraction
  2. Omnilux
  3. IPL
  4. Azelaic acid
  5. Salicylic acid
  6. Over-the-counter retinoids

Although blackheads can be treated by extraction, topical treatment is a better option for managing this stage of acne. Azelaic acid, salicylic acid and over-the-counter retinoids work by dissolving bacteria and dead skin cells from clogged pores. Salicylic acid is also able to prevent non-inflammatory acne from recurring.

For faster results, supplement your acne treatment with Omnilux, a completely painless, but highly effective phototherapy procedure that uses red and blue light to eliminate acne-causing bacteria. This procedure, along with extraction and IPL, is available at EHA Clinic. You can arrange a consultation with Dr. Elias Tam at EHA Clinic to discuss the best acne treatment plan for you.


Whiteheads are formed when dead skin cells, bacteria and sebum collect under the skin and protrude as little flesh-coloured bumps.

Recommended treatment options: 

  1. Omnilux
  2. IPL
  3. Azelaic acid
  4. Salicylic acid
  5. Over-the-counter retinoids
  6. Prescription retinoids

Unlike blackheads, whiteheads should not be extracted manually because the heads of these pores are closed. Topical treatment is your best option for this non-inflammatory stage of acne. The same treatments that work for blackheads apply to whiteheads as well. If you have a severe case of whiteheads, you might want to consider consulting Dr Elias Tam for a prescription of topical retinoids. Retinoids are very effective for unclogging pores full of oil and dead skin cells.

You can also supplement your treatment with Omnilux or IPL (Intense Pulsed Light), which uses quick pulses of intense light to destroy acne-causing bacteria and subdue overproducing sebum glands. This procedure, along with Omnilux, is available at EHA Clinic. You can arrange a consultation with Dr. Elias Tam at EHA Clinic to discuss the best acne treatment plan for your skin condition.


Papules are formed when the body reacts to the dead skin cells, bacteria and sebum collecting under the skin, causing inflammation to occur. As a result, the bump swells and turns an angry red. They are sometimes painful to the touch.

Recommended treatment options:

  1. Omnilux
  2. IPL
  3. PICO Laser
  4. Over-the-counter benzoyl peroxide
  5. Prescription retinoids
  6. Azelaic acid
  7. Topical antibiotics

Papules can be effectively treated with over-the-counter benzoyl peroxide because of its antibacterial properties. Azelaic acid and topical retinoids are also good options due to their ability to reduce inflammation and eliminate bacteria. Note that salicylic acid works best on non-inflammatory acne and is not effective on papules which are a stage of inflammatory acne.

If your acne breakout is severe, you can consult Dr. Elias Tam at EHA Clinic for a prescription of topical antibiotics. Topical antibiotics are very effective in eliminating P.acnes, an acne-causing bacteria in sebum, and decreasing androgen levels as well.

It is important to bear in mind that topical antibiotics lose their effectiveness after more than two months of continuous use. To prevent this, we recommend combining your course of  antibiotics with the use of a benzoyl peroxide cream. An alternative to antibiotics is PICO Laser, a photothermal treatment that has a similar effect  as antibiotics —killing acne-causing bacteria with the added benefit of dissolving hardened sebum for easier extraction.

This procedure, along with Omnilux and IPL, is available at EHA Clinic. You can arrange a consultation with Dr. Elias Tam at EHA Clinic to discuss the best combination of treatments for your acne problem.


Pustules are papules with pus accumulating at the centre of the red bump. This occurs when the immune system fights the bacteria invading the skin with white blood cells. The dead white blood cells are what make up the yellowish centres of pustules.

Recommended treatment options: 

  1. Extraction
  2. Omnilux
  3. IPL
  4. PICO laser
  5. Over-the-counter benzoyl peroxide
  6. Prescription retinoids
  7. Azelaic acid
  8. Topical antibiotics
  9. Prescription benzoyl peroxide

Pustules can be extracted to drain the pus. It is better to get a trained professional to perform  the extraction for you to prevent bacterial infection and scarring. You can get your extractions, Omnilux, IPL  and PICO laser treatments done at EHA Clinic.

The same topical treatments for papules apply to pustules as well, although, for severe cases, topical antibiotics and benzoyl peroxide are better options.

For a personalised acne treatment customised for your skin, consult Dr. Elias Tam at EHA Clinic.

Nodules/ Cysts

Nodules and cysts are the most severe of the 5 stages of acne. They are formed when dead skin cells, bacteria and sebum get pushed deeper into the skin, causing a larger area to be inflamed and filled with pus. These acne lesions are very large and often painful to the touch.

Recommended treatment options:

  1. IPL
  2. PICO laser
  3. Mosaic eCO2 laser
  4. Steroid injections
  5. Prescription benzoyl peroxide
  6. Prescription retinoids
  7. Topical antibiotics
  8. Oral antibiotics
  9. Hormone pills

You should get professional help for nodules and cysts. Over-the-counter medications tend to treat acne on a surface level, making them ineffective for treating nodules and cysts. If you have multiple nodules and cysts, Dr. Elias Tam might recommend oral antibiotics or hormone pills to treat your acne condition from the inside out.

Alternatively, you can use steroid injections to shrink a particularly large nodule or cyst quickly or Mosaic eCO2 laser to remove deep-seated cysts with minimal scarring. These procedures are available at EHA Clinic and can be arranged after a consultation with Dr. Elias Tam about your specific acne problems.

The Importance of a Comprehensive Treatment Plan

Most people have a combination of a few stages of acne at once. If you have a nodule or cyst, you’ll most likely have a few pustules, papules as well as whiteheads and blackheads. So, the best acne treatment plan is one that deals with the variety of factors causing your acne condition.

An effective, long-lasting solution to acne is one that focuses on limiting P.acnes (acne-causing bacteria) and sebum production.

And let’s be realistic, there is no one cream to treat them all.

A comprehensive treatment plan by a trained medical doctor is the best long term solution to this common yet painful problem. Each stage of acne has to be dealt with individually in order to properly resolve stubborn acne and persistent breakouts.

For professional advice on a comprehensive and effective treatment plan for your unique acne problem, book a consultation with Dr. Elias Tam at EHA Clinic.

1 Torjesen, Ingrid, “Avoid antibiotics for acne treatment when possible” published July 2, 2018, Dermatology Times, July 2018 (Vol. 39, No. 07), accessed from

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