Papules vs Pustules: Reading the Pimples on Your Face

Papules and pustules are both inflamed acne spots; the difference is pus. A papule is a small, firm, red or darker bump with no visible head. A pustule is the same kind of bump with a white or yellow center of pus. Both respond to benzoyl peroxide or salicylic acid washes, and neither should be squeezed, especially a papule, which has nothing at the surface to release.

Below is the full acne "ladder," from clogged pores to deep cysts, with a table describing what each lesion looks and feels like, what it means for treatment, and when the type of spot you have is a signal to see a dermatologist.

What are the types of acne pimples?

Acne lesions fall into two broad groups: non-inflamed comedones and inflamed spots that range from papules to nodules and cysts. DermNet describes acne as open and closed uninflamed comedones (blackheads and whiteheads), inflamed papules and pustules, and in severe acne, nodules and pseudocysts. The NHS lists the same set and notes that you may have more than one type at a time.

Think of them as steps on a ladder. Each step down sits deeper in the skin, carries more inflammation and is more likely to leave a mark.

The descriptions draw on the AAD's guide to acne blemish types and the NHS description of papules, pustules, nodules and cysts. The comedone end of the ladder has its own guide: how to get rid of whiteheads.

What is a papule?

A papule is an early inflamed pimple: a small, firm bump with no head. The AAD explains that papules appear when excess oil, bacteria and dead skin cells push deeper into the skin and cause inflammation, and notes that they feel hard. If you have many of them, the area may feel like sandpaper.

The color depends on your skin tone. The NHS points out that papules look pink or red on white skin, and may look brown or purple on brown and black skin. That matters if you're comparing your face to photos online, most of which show lighter skin.

What is a pustule?

A pustule is a papule that has filled with pus. The AAD describes pustules as a lot like papules, except that they contain a yellowish fluid, usually visible as a white or yellow center. This is the spot most people call a "whitehead" in everyday speech, though dermatologists reserve that word for closed comedones.

Papules vs pustules: what's the real difference?

The visible difference is the head of pus; the practical difference is mostly about what you do with your hands. Both are inflamed, both sit at roughly the same depth, and the AAD recommends the same first step for each: a face wash with benzoyl peroxide or salicylic acid.

• Papule: red or darker, firm, tender, no head. Squeezing only pushes on inflamed tissue.
• Pustule: raised with a white or yellow center. Looks like it wants to be popped. The AAD says to resist the temptation, because popping can worsen acne.

Why shouldn't you squeeze a red bump with no head?

Because there's nothing at the surface to come out, so squeezing just drives inflammation deeper. The AAD warns that when you push the contents of a pimple deeper into the skin, which often happens, you increase inflammation, which can lead to more noticeable acne, pain and scarring. Bacteria from your hands also raise the risk of infection.

A red bump with no head can also be the top of something deeper. The AAD notes that with a nodule or cyst you might not be able to see it, but can still feel the painful lump. If a headless bump is large, hard and sore, treat it as a possible nodule and leave it alone.

What to do instead:

1. Keep your hands off. The AAD lists touching, picking and popping as things that can worsen acne.
2. Use ice for pain. The AAD says ice reduces the inflammation of painful spots.
3. For a deep, painful spot, the AAD suggests a warm, damp washcloth for 10 to 15 minutes, three times a day, to help bring it closer to the surface, using a clean cloth each time.
4. Apply a thin layer of an acne treatment. The AAD lists adapalene, azelaic acid, benzoyl peroxide or salicylic acid as over-the-counter options.

How do you treat papules and pustules?

Start with an over-the-counter benzoyl peroxide or salicylic acid product, used consistently for six to eight weeks. The AAD recommends washing twice daily with an acne face wash containing one of the two, and says to see a dermatologist if you don't see results in six to eight weeks or if you have a lot of papules.

The 2024 AAD guidelines for acne give strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline, and conditional recommendations for salicylic acid and azelaic acid, among others. They also recommend combining topical treatments that work in different ways. In practice that often means a retinoid such as adapalene at night plus a benzoyl peroxide wash, which treats inflamed spots and the clogged pores they grow from. For more on choosing a wash, see our guide to face washes for acne.

What about nodules and cysts?

Nodules and cysts are the deep end of the ladder, and they usually need a dermatologist. The AAD says these blemishes penetrate deep into the skin and often cause permanent acne scars, and that the sooner treatment starts, the fewer permanent scars you'll have. DermNet adds that for nodulocystic acne topical treatment is usually ineffective and oral isotretinoin is the recommended treatment, started early to prevent scarring. Our guide to treating cystic acne covers what helps at home in the meantime.

How do lesion types relate to acne severity?

Severity depends on how many lesions you have and how deep they go. DermNet classifies acne by total lesion count: mild under 30, moderate 30 to 125, and severe over 125. Depth changes the picture too: even a handful of nodules or cysts is treated more seriously than many comedones, because of the scarring risk. The AAD notes that you're more likely to scar if you develop deep, painful acne or pop, pick, squeeze or scratch your breakouts. Our explainer on acne severity grading goes through the scales dermatologists use.

Do papules and pustules leave scars?

Most leave a temporary mark that fades, and picking raises the odds of a lasting scar. The AAD explains that a flat spot of color left after acne clears usually isn't an acne scar but post-inflammatory hyperpigmentation, which tends to fade. Not every breakout scars, and the AAD's advice for prevention is simple: treat acne early and never pick, pop, scratch or squeeze, because more inflammation means a higher chance of scarring. If your marks are pink or red rather than brown, our guide to red marks after acne explains why they linger.

When should you see a dermatologist?

See a dermatologist if your spots aren't improving after six to eight weeks of over-the-counter treatment, if you have many papules, or if any lesions are deep and painful. The NHS also advises seeing a doctor if the spots are deep, painful or causing scars, if there are signs of a skin infection such as hot, swollen and red skin, or if acne is affecting your mental health.

How can a selfie scan help you track your spots?

A scan won't name your lesions, but it can show whether your skin is trending in the right direction. Pori doesn't label individual spots as papules, pustules or cysts. It reads a selfie region by region using a 468-point face mesh and returns an overall skin score with a Pores & Texture breakdown, and its before/after view and progress charts let you compare the same areas of your face across weeks of treatment. Pairing those scans with notes in the skin diary on sleep, stress and diet can help you spot patterns to raise with a dermatologist.

An app is not a diagnosis. Telling a papule from a nodule, or acne from a look-alike condition, is a dermatologist's job, so get anything painful, deep or persistent checked in person.