Papule: Cause, Treatment, and Prevent

by | Aug 26, 2020

Many papules on the cheeks


The appearance of papule is a small hill raised on the surface of the skin, its diameter is generally within 1cm. There are black spots or translucent fat plugs in the center of the papules, and cannot be squeezed out yellow pus from the inside.

It feels painful and itchy when it comes to papules. This is because the hair follicles become inflamed, causing the epidermis to break, so you will feel pain. At the same time, there is more oil secretion, the epidermis will breed a lot of bacteria, and it will feel itchy.

Papule is a moderate grade inflammatory acne, it is a chronic folliculitis. If handled properly, it will be eliminated quickly. If not handled properly, papules will easily develop into pustules, nodules, or cysts.

There are dozens of pimples on the right side of the mouth, and the area of the pimples is framed by a black oval line. There are more papules, but their size is small.


Macule vs Papule

There are dense macules on the nose and cheeks


Papules and Macules look about the same size. But they are essentially different.

The macules on the skin are not inflamed, the surface of the skin turns black, and there are no bumps or depressions. The macules will stay on the skin for a long time, which is difficult to eliminate.

Papules appear red when inflamed, and when it is touched, it feels raised and painful. When the inflammation is gone, it may leave pigmentation. The surface of the skin appears black, which will disappear over time.

What Causes Papules?

Acne formation animation

The most fundamental cause of papule formation is hyperkeratosis at the hair follicle funnel and excessive sebum production.


The structure of the sebaceous glands. The sebaceous glands connect the hair follicle channels, and the sebum secreted by the sebaceous glands and the dead cells shed from the stratum corneum are excreted through the channels. However, if the cells at the funnel of the hair follicle cannot fall off normally, the pores are covered, and sebum and dead cells are blocked inside the hair follicle.

Our skin is exfoliating keratinocytes every day. The normal shedding cycle of these keratinocytes is 28 days. However, due to some reasons, the keratinization process at the funnel of the hair follicle is abnormal, and the keratinocytes stick together and cannot fall off normally. Keratinocytes accumulate more and more in the pores, and will eventually cover the opening of the hair follicle and form whiteheads.

If the whiteheads are keratinocyte blocked at the opening of the hair follicle, then the papule is to block the sebaceous duct or even the sebaceous glands.

Excessive sebum production

The sebaceous glands secrete oil every day, and these oils flow out of the pores through the channels before they can flow to the surface of the skin that we can see.

If the oil production is too strong, the keratinization of the hair follicle funnel will be abnormal, which will cause the pores to be gradually blocked.

The sebaceous glands do not know that the pores are blocked, and they continue to secrete sebum. The oil and dead cells will mix to form a sebum plug, which will cause the oil flow channel to be insufficient.

An anaerobic environment is formed inside the hair follicle. Propionibacterium acnes takes advantage of the multiplication and bacteria will stimulate the skin to produce inflammatory papules.

Why do sebaceous glands secrete so much oil?

  • Perhaps your genetic sequence determines that you secrete more sebum than others.
  • Ultraviolet rays stimulate the sebaceous glands to secrete oil.
  • A high-sugar diet, the high-salt diet will stimulate a spike in insulin in the body, which indirectly stimulates androgens, which then leads to strong sebum production.
  • Excessive cleaning will stimulate the skin to secrete more oil.
  • Staying up late will cause a large number of androgens to be secreted, which in turn will produce more oil.
  • The growth hormone is active during adolescence, and adolescence is the most active period of sebaceous glands. After 20 years of age, the activity of sebaceous glands will decrease year by year.
  • During menstruation, the ovaries produce a small number of androgens, so it will cause the sebaceous glands to spit out a lot of oil at once.
  • Certain diseases, such as polycystic ovary syndrome, also produce androgens

Fortunately, papule belongs to a relatively low degree of inflammation, and the number of bacteria is not very large. As long as we do anti-inflammatory and sterilization work, we can quickly eliminate papules.

How To Get Rid Of Papule?

Papular acne is moderate acne. You can use over-the-counter drugs first. If you don’t get better within a week, or even worse, you need to see a dermatologist. The dermatologist will give you prescription medications to treat papules.

Effective over-the-counter treatment for papules include:

Adapalene (Differin):

Adapalene belongs to the third generation of retinoic acid, which can inhibit hyperkeratosis at the hair follicle funnel and clear the passage of sebum outflow. At the same time, Differin also has anti-inflammatory, oil control, and whitening functions, which can effectively eliminate mild and moderate acne.

Comparison before and after using adapalene. There were dozens of papules and whiteheads on the face before using adapalene. After using adapalene, the face is white and flawless, and the acne is completely eliminated.
Comparison before and after using adapalene. There were dozens of papules and whiteheads on the face before using adapalene. After using adapalene, the face is white and flawless, and the acne is completely eliminated. And the skin is still darker, using Differin makes the skin white.

From the official website: skin condition before and after using adapalene

Benzoyl peroxide gel:

The benzoyl peroxide gel is highly oxidizing. There are a lot of anaerobic bacteria in the papules. Benzoyl peroxide gel can release new ecological oxygen and benzoyl in the skin. It destroys the habitable environment of anaerobic bacteria and kills the bacteria in the papules, thereby eliminating the papules.

The medicine prescribed by the doctor:


Papules have inflammation only in the shallower epidermis. It is easy to get rid of papules by applying antibiotics to the skin surface. Common topical antibiotics include clindamycin phosphate gel and fusidic acid cream.

These two drugs have a good effect on moderate acne. Both antibiotics will be used once in the morning and evening, and the papules will disappear after a few days. But bacteria are resistant to antibiotics, and the effect of antibiotics will become worse and worse after long time use.

How To Prevent Repeated Papules?

If you want to prevent repeated acne, you need to have good eating habits, lifestyle habits, and correct skin care habits

  • Reduce stress, do not stay up late, eat more fruits, vegetables, and fermented foods
  • Avoid eating spicy, reduce chocolate, sweets, high GI foods, milk, and fried greasy foods. Reducing caffeine intake helps maintain hormonal balance and remove acne on the face. Please see this article for the acne muscle diet.
  • Avoid skin irritation. Wash your face with amino acid facial cleanser once in the morning and evening, and do not rub hard.
  • Do not grab your face with your hands, and keep your hair and pillows clean.
  • Use skin care products containing repair ingredients to ensure the health of the skin barrier. Only a healthy skin barrier can prevent the invasion of bacteria, inhibit inflammation, and avoid various skin problems.
  • Use skin care products containing retinol regularly. Retinol will eventually be converted into retinoic acid inside the skin, which can inhibit the secretion of skin oil and clear the pores of the skin.
  • Regularly use skin care products containing alpha hydroxy acid (AHA) or salicylic acid to help exfoliate, clear pores, and reduce the chance of acne.
  • Sun protection, avoid direct UV radiation on the skin. When ultraviolet rays are irradiated into the skin, free radicals are generated in the skin, which can cause acne on the skin. At the same time, ultraviolet rays can also cause skin aging.