Pustular Acne ICD-10: L70.0

Acne / Inflammatory skin condition

Often searched as: pimples with pus, white head pimples, pimples that hurt, acne with yellow tip, pustules on face, pimples that leave marks, acne on back and chest, painful pimples…

Clinical urgency level

lowmediumhigh

Systems Affected

skinhair folliclessebaceous glands

Severity Levels

mild

A few isolated pustules on the face, resolving within days without scarring — manageable with topical benzoyl peroxide or salicylic acid.

moderate

Multiple pustules across face, chest, or back, recurring regularly, with possible post-inflammatory marks — benefits from prescription topical or oral antibiotics and retinoids.

severe

Widespread, painful pustules with deep nodules or cysts, significant risk of scarring — requires dermatologist treatment, possibly isotretinoin (Accutane).

Red Flags

Pustules that are very painful, large, and deep (nodular or cystic acne)
Visible scarring or pitting developing from recurring lesions
Acne flaring severely in an adult woman — possible hormonal disorder (PCOS)
Sudden onset of widespread pustules in someone not previously prone to acne (rule out drug reaction or gram-negative folliculitis)
Pus-filled lesions that don't respond to 2–3 months of treatment
Significant psychological distress, anxiety, or social withdrawal due to acne

Clinical Presentation

Pustular acne — red inflamed papules and pustules on the face

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Pustular acne image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

See a dermatologist if pustular acne is recurring, spreading, or leaving marks, if over-the-counter treatments aren't working after 2–3 months, or if acne is causing significant emotional distress. Early treatment prevents scarring — don't wait too long.

Differential Diagnosis

Rosacea (pustules on central face, no comedones, triggered by heat/alcohol)
Perioral dermatitis (small pustules around mouth)
Folliculitis (infected hair follicles — often from shaving or occlusion)
Gram-negative folliculitis (after long-term antibiotic use for acne)
Fungal acne / Malassezia folliculitis (uniform itchy pustules on trunk)
Steroid acne (from topical or systemic corticosteroids)

Comorbidities

Polycystic ovarian syndrome (PCOS) — hormonal acne in women
Hyperandrogenism
Seborrheic dermatitis (co-occurring oily, flaky skin)
Depression and anxiety (acne significantly impacts mental health)
Post-inflammatory hyperpigmentation and scarring

Prognosis

Pustular acne responds well to treatment. Topical retinoids and benzoyl peroxide are first-line and effective for mild cases. Oral antibiotics combined with retinoids work for moderate cases, though antibiotic resistance is a growing concern limiting long-term use. Isotretinoin (Accutane) achieves long-term remission or cure in 85% of severe cases after a single course. Hormonal therapies (oral contraceptives, spironolactone) are very effective for hormonal acne in women. Scarring, the main long-term complication, is best prevented by early treatment.

Detailed Overview

Causes, Symptoms, and When to Take Action Pustular acne is a form of inflammatory acne where bumps develop pus, indicating a deeper inflammation. These lesions are more visible and often more uncomfortable than simple non-pus bumps. How It Looks Texture: Raised, inflamed bumps with a visible pus-filled tip (pustule) Color: Red and swollen base with yellowish or whitish pus at the top Shape: Round or dome-shaped pimples; may be singular or appear in clusters Location: Common on the face, chest, back, shoulders, and upper arms Why Does It Appear? Pores or hair follicles become clogged with excess oil and dead skin cells Bacteria on the skin multiply inside blocked pores, leading to pus formation Hormonal changes can increase oil production, exacerbating the problem Visible inflammation results from the immune system's response to the bacterial overgrowth Should You Be Concerned? Pustular acne is usually not dangerous, but it can cause issues such as: Pain and irritation at the affected sites Increased risk of temporary or permanent scarring if lesions are frequently disturbed Emotional distress or self-consciousness due to visible lesions If pustules are widespread, very painful, or last a long time, it's advisable to seek medical assessment. Can You Prevent It? Avoid touching, squeezing, or picking pustules Keep skin clean and avoid products that clog pores Be alert to early signs of inflammation to act before deeper lesions develop 👉 How Piel AI Can Help Piel AI helps you monitor pustular lesions over time through images. While not a diagnostic tool, it helps you detect changes in severity, quantity, or healing, enabling earlier consultation when needed. Summary Pustular acne features inflamed bumps containing pus. Caused by clogged pores, bacterial growth, oil, and immune response. Can be painful and may leave scars if not handled carefully. Prevention focusses on hygiene, avoiding irritation, and early recognition.

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