Monday, May 16, 2022

Causes, Treatments, Natural Remedies and More

  • Acne pustules are indicative of mild-to-severe inflammatory acne
  • They develop due to accumulated dirt, sebum and bacteria within pores
  • Acne pustules present as inflamed and painful bumps with white or yellow pus-filled centers
  • Treatment includes over-the-counter and prescription-strength medications, as well as natural remedies

Acne vulgaris is a very common skin condition that can be categorized as noninflammatory or inflammatory. Acne pustules are a symptom of the latter, and indicate an active infection. These pustules are painful small to large pus-filled bumps on the skin. Many established over-the-counter (OTC) and prescription options are formulated to target these pustules. Acne breakouts can be both treated and managed with the right therapy.

What Are Acne Pustules?

Acne can cause a range of lesions to develop and identifying the lesion is based on type as well as severity: mild, moderate or severe. Of note is that acne is graded not only on the type of lesion but the lesion count. Therefore, while comedones are less obtrusive and do not cause discomfort, they can still be classified as moderate or severe.   

Noninflammatory acne refers to pimples, whiteheads and blackheads. Pimples are small lesions that typically heal quickly, while whiteheads (closed comedones) and blackheads (open comedones) are a result of sebum (oil), dirt, debris and dead skin cells that accumulate to block pores.  

Cutibacterium acnes bacteria is naturally present within follicles but when trapped, will proliferate and cause noninflammatory acne to degrade to inflammatory acne. When the immune system automatically responds by sending antibodies to fight this bacteria, depending on the severity of infection, small to large pus-filled bumps form.

Pustules vs. whiteheads

Pustules are very different from whiteheads.

Whiteheads, also called comedones, are noninflammatory lesions. They are small bumps that are white in color due to a thin layer of skin over top that prevents the plug from changing color due to exposure to air. They form beneath the skin’s surface. 

As with pustules, these are a buildup of oil and debris in pores but unlike pustules, there is an absence of bacteria. There is no inflammation, redness, infection or swelling involved.

Pustules are characterized by these signs of inflammation and are red or pink in color; they appear as small tender bumps on the skin’s surface.  

Pustules vs. papules

Pustules and papules are similar in appearance and develop when comedones become infected with C. acnes bacteria. Both are inflamed raised bumps, small in size and typically painful.

The primary difference between the two lesions is that pustules are papules that have formed a head of pus.

What Causes Acne Pustules to Form?

Acne is one of the most common chronic skin diseases in the United States and affects adolescents as well as adults. It is associated with hormonal changes, genetics, diet, stress, and some skin disorders. 

Pustules are one type of lesion associated with acne and is a typical manifestation of inflammatory acne.    

Acne develops when pores become congested with oil, dead skin cells and debris to form comedones or pimples. If left untreated, bacteria can accumulate and cause inflammatory acne lesions to form. 

When the body identifies an infection, it responds by sending neutrophils, a type of white blood cell, to attack and kill the bacteria. During this stage, some of the neutrophils and affected tissue will die at the infection site; pus consists of this dead material and is white or yellowish-white in color. The inflammation also causes redness, swelling and pain.

Where are they likely to occur? 

Pustules can develop anywhere on the body, but are most often seen where oil glands are more abundant. These areas include the: 

Should You Pop a Pustule?

It may be tempting to pop or pick at pustules. However, doing so means you’re more likely to transfer additional bacteria to your face and spread the infection. This also increases the risk of scarring.

Should you decide to do so, you can mitigate any risks by following certain steps. Wash your hands thoroughly and apply a warm compress to the affected area for several minutes before gently squeezing. Do not apply force; if the pustule does not pop, wait another day and try again.

Afterward, cleanse the area gently with a medicated cleansing wash containing benzoyl peroxide or tea tree oil to target bacteria in the pore. You could also apply a thin layer of antibacterial ointment to speed up healing.  

Acne Pustule Scarring

Squeezing or picking at a pustule can push infected bacteria and debris deeper into the pore. You can also transfer bacteria from your fingers to your skin and increase the infection. These actions cause greater swelling and inflammation, prolongs the healing process and potentially scars the skin.

OTC Treatments for Acne Pustules

OTC treatments for acne pustules work in several ways: to open up pores and remove excess oil, to exfoliate dead skin cells and debris and to kill acne-causing bacteria.

Azelaic acid

Azelaic acid is a natural dicarboxylic acid found in creams, lotions and washes. It has anti-inflammatory qualities, prevents cell damage and inhibits the growth of C. acnes. It can also be combined with benzoyl peroxide or hydroxy acids for greater efficacy. 

Benzoyl peroxide

One of the most effective acne treatments available, benzoyl peroxide heals pustules by removing excess oil, dead skin cells and the bacteria that causes them to form.

For those with dry or sensitive skin, it would be best as a spot treatment to target individual blemishes as benzoyl peroxide can cause excessive peeling.

Hydrogen peroxide

A recent study has shown topical application of hydrogen peroxide yields comparable results to benzoyl peroxide. It can dry out pore-clogging excess oils and as an oxidizing agent, it can kill bacteria. 

However, it can also kill skin cells as well as the connective tissue (fibroblasts) that helps heal wounds. As there may be an increased chance of scarring, it’s important to use hydrogen peroxide as directed; speak to your doctor first to ensure it’s the right treatment for you. 


Topical retinoids play an important role in acne treatment and are considered a first -line treatment. They are typically paired with antimicrobial agents such as benzoyl peroxide for greater results and importantly because C. acnes has not yet developed resistance to these agents.

Tretinoin, a form of vitamin A, prompts exfoliation and speeds up skin cell turnover to clear pores. This retinoid is also an anti-inflammatory and helps the skin regulate sebum production, preventing further breakouts.

Salicylic acid

Salicylic acid has anti-inflammatory and antibacterial properties to help heal acne pustules. It can effectively break down the bonds between dead skin cells in a process called desquamation, allowing these cells to shed and allowing new cells to take their place.

While it can exfoliate skin and unblock pores, it does not affect sebum production or bacterial growth.

A common ingredient in a wide range of OTC acne treatments, including creams, lotions and pad wipes, it’s not recommended to use alongside other products, such as benzoyl peroxide, because of the risk of excessive dryness.  

Sulfur topicals

Sulfur topicals work much like salicylic acid and benzoyl peroxide but are gentler on the skin. They tend to have an odor so are less popular than other acne treatments. Some products may also combine sulfur with other acne-fighting ingredients such as resorcinol.

Sulfur is not strong enough to be effective against moderate or severe forms of acne but it is for mild forms. It has antifungal and antibacterial properties to inhibit bacterial growth and is effective in exfoliating the skin and drying excess oil. 

While sulfur is less effective than benzoyl peroxide, it may be a good option if you have very sensitive skin.

Natural Remedies for Acne Pustules

Some natural remedies have proven effective to help bolster the effects of OTC treatments and to soothe discomfort that often accompanies acne pustules. These include ingredients that draw out excess sebum and debris from pores, soothe inflamed skin and target bacteria:

  • Essential oils such as tea tree and rosemary oil, have anti-inflammatory and antimicrobial properties that are proven to reduce the redness, swelling, bacterial infection and pain of acne lesions
  • Aloe vera gel has antibacterial and anti-inflammatory properties to heal acne pustules and reduce the associated tenderness and pain
  • Natural masks such as those that contain jojoba oil or bentonite can help reduce pustules because they draw oil and debris from pores. 

When to Seek Medical Attention 

If your pustules are resistant to OTC or natural remedies, or your pustules become severe and increasingly painful, you should see your dermatologist. Leaving your acne pustules untreated can lead to the development of cystic acne; a much more severe acne diagnosis that is more challenging to treat.

Cystic acne develops when the bacterial infection of pustular acne deepens beneath the skin, producing red, tender pus-filled bumps. The risk of scarring increases significantly with this form of acne.

Cystic acne requires the attention of a medical professional and more aggressive treatment options, including oral and topical antibiotics, topical retinoids, steroid injections and lancing.


Acne pustules are a symptom of mild, moderate or severe acne and develop when pores become blocked with debris and bacteria which results in an infection.

The immune system responds by sending white blood cells to combat this infection. The result is an inflammatory response that results in redness, swelling, pain and pus.

Several OTC treatments as well as home remedies are effective in treating and preventing  pustular acne. They do so by drying out or removing excess oils, clearing pores of debris and dead skin cells, killing bacteria and reducing inflammation.

Acne pustules that increase in severity may require treatment by a dermatologist to rule out a diagnosis of cystic acne, the most severe form of acne vulgaris.


  • Bernardis E, Shou H, Barbieri JS, et al. Development and Initial Validation of a Multidimensional Acne Global Grading System Integrating Primary Lesions and Secondary Changes. JAMA Dermatol. 2020;156(3):296–302. doi:10.1001/jamadermatol.2019.4668
  • [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Acne: Overview. 2013 Jan 16 [Updated 2019 Sep 26]. Available from:
  • Marks G et al. Structure and Function of the Skin. In: Marks J and Miller J (eds). Lookingbill and Marks’ Principles of Dermatology. 6th ed. Elsevier; 2019.
  • Bernardis E, Shou H, Barbieri JS, McMahon PJ, Perman MJ, Rola LA, Streicher JL, Treat JR, Castelo-Soccio L, Yan AC. Development and Initial Validation of a Multidimensional Acne Global Grading System Integrating Primary Lesions and Secondary Changes. JAMA Dermatol. 2020 Mar 1;156(3):296-302. doi:10.1001/jamadermatol.2019.4668
  • Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. 2012 Jan 28;379(9813):361-72. doi:10.1016/S0140-6736(11)60321-8
  • Malech HL, Deleo FR, Quinn MT. The role of neutrophils in the immune system: an overview. Methods Mol Biol. 2014;1124:3-10. doi:10.1007/978-1-62703-845-4_1
  • Oge’ LK et al.. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019;100(8):475-484.
  • Webster G. Combination azelaic acid therapy for acne vulgaris. J Am Acad Dermatol. 2000;43(2 Pt 3):S47-S50.
  • Fox L, Csongradi C, Aucamp M, du Plessis J, Gerber M. Treatment Modalities for Acne. Molecules. 2016;21(8):1063. Published 2016 Aug 13. doi:10.3390/molecules21081063
  • Veraldi S, Micali G, Berardesca E, Dall’Oglio F, Sinagra JL, Guanziroli E. Results of a Multicenter, Randomized, Controlled Trial of a Hydrogen Peroxide-based Kit versus a Benzoyl Peroxide-based Kit in Mild-to-moderate Acne. J Clin Aesthet Dermatol. 2016;9(10):50-54.
  • Kolli SS, Pecone D, Pona A, Cline A, Feldman SR. Topical Retinoids in Acne Vulgaris: A Systematic Review. Am J Clin Dermatol. 2019 Jun;20(3):345-365. doi:10.1007/s40257-019-00423-z
  • Decker A, Graber EM. Over-the-counter Acne Treatments: A Review. J Clin Aesthet Dermatol. 2012;5(5):32-40.
  • Sparavigna A, Tenconi B, De Ponti I, La Penna L. An innovative approach to the topical treatment of acne. Clin Cosmet Investig Dermatol. 2015;8:179-185. Published 2015 Apr 9. doi:10.2147/CCID.S82859
  • Winkelman WJ. Aromatherapy, botanicals, and essential oils in acne. Clin Dermatol. 2018 May-Jun;36(3):299-305. doi:10.1016/j.clindermatol.2018.03.004
  • Meier L, Stange R, Michalsen A, Uehleke B. Clay jojoba oil facial mask for lesioned skin and mild acne–results of a prospective, observational pilot study. Forsch Komplementmed. 2012;19(2):75-9. doi:10.1159/000338076

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