Do you know what types of acne you have?
There are multiple types of acne that fit into four grades. Knowing the grade of your acne is an important step towards treating it. Each grade is determined by a visual evaluation of:
- Types of non-inflamed comedones
- Types of inflamed comedones
- Amount of breakout activity
- Amount of inflammation, if any
- Areas of the body affected by acne
Comedones, or blemishes, all begin as a blockage of oil and dead skin cells within the hair follicle. When bacteria infect a comedone, inflammation occurs. Inflammation appears as redness, swelling and pain.
Below are the four grades of acne, followed by a detailed explanation of the different types of acne.
Grade I Acne
Grade I acne is the mildest form of acne. This includes minor, small pimples that appear only occasionally and in very few amounts. However, there may be many blackheads and whiteheads. There is no inflammation. Grade I acne happens frequently in early adolescence, especially on the nose and/or forehead and can successfully be treated at home using over-the-counter products that contain salicylic acid, and results are generally seen quickly. If left untreated, Grade I acne can progress into Grade II.
Whiteheads: Result when a pore is completely blocked, trapping sebum (oil), bacteria, and dead skin cells causing a white appearance on the surface. Generally have a shorter life cycle than blackheads.
Blackheads: Blackheads appear when a pore is only partially blocked, so that some of the trapped sebum (oil), bacteria, and dead skin cells slowly drain to the surface. The black color is caused by the skin’s own pigment, melanin, reacting with the oxygen in the air, rather than caused by dirt.
Grade II Acne
Grade II is considered a moderate form of acne and includes greater numbers of blackhead and whiteheads. Breakouts become more obvious and there is a slight inflammation of the skin. Papules and the formation of pustules appear in greater frequency. Grade II is common in teens, where acne can progress from the nose and forehead to other areas of the face, as well as the chest, shoulders and occasionally the back, especially in males. Adult women may find that just before and during their menstrual cycles, they experience breakouts on the cheeks, chin and jaw line. Grade II acne can be treated at home using over-the-counter products that contain both salicylic acid and benzoyl peroxide, such as Proactiv. Grade II may progress into Grade III, especially if pimples are picked or squeezed habitually.
Papules: Inflamed, red, tender bumps with no head. Squeezing a papule will only exacerbate scarring.
Pustules: Inflamed, appears as a red circle with a white or yellow center. These are what are commonly referred to as “zits”.
Grade III Acne
The difference between Grades II and III is the amount of inflammation present. Considered severe acne, the skin is now obviously reddened and inflamed. There are greater numbers of papules and pustules, as well as nodules. Grade III acne often affects other body areas, such as the neck, chest, shoulders and/or upper back, as well as the face. The chance of scarring increases as the infection spreads and goes deeper into the skin. If Grade III acne occurs, a dermatologist should be contacted for topical and systemic (internal) therapies available only by prescription. If left untreated, Grade III can become Grade IV acne.
Nodules: Acne spots are much larger and can be quite painful, sometimes lasting for months. Nodules are large, hard bumps under the skin’s surface. Unresolved nodules can sometimes leave an impaction behind, which can flare again and again; scarring is common. It is important not to attempt to squeeze nodules, because this can cause severe trauma to the skin and cause it to last longer than it normally would.
Grade IV Acne
As the most serious form of acne, Grade IV includes very painful cystic acne. There is a significant amount of inflammation and severe breakouts, including numerous papules, pustules, nodules, as well as cysts. Grade IV acne may affect the entire back, chest, shoulders, and upper arms. Because it tends to be hard to control, Grade IV acne must be treated by a dermatologist for powerful systemic medications as well as topical treatments.
Cysts: An acne cyst can appear similar to a nodule, but has a diameter of 5mm or more across, is pus-filled and often painful. Scarring is common; squeezing an acne cyst may cause a deeper infection and more painful inflammation.
Another Type of Acne
Acne Rosacea affects millions of people, mostly over the age of 30 and largely in women. It initially appears as a red rash, normally confined to the cheeks, nose, forehead, and chin, and is accompanied by bumps, pimples, and skin blemishes though not blackheads. Blood vessels may also become more visible on the skin. If untreated, rosacea can cause swelling of the nose and the growth of excess tissue, known as rhinophyma. Acne and rosacea treatments are different, so contact a dermatologist if you think you are experiencing rosacea.
