Common use of the term “acne” tends to be all encompassing and might include any type of blemish that might affect the skin, primarily on the face. If you have acne, you might think that’s all you need to know.
But you’ve probably noticed that acne severity varies widely from person to person. Your particular case of acne may even change periodically, depending on conditions like stress and hormone levels.
Actually, dermatologists classify acne into four different types based on form and severity. Understanding the four different types of acne will help you to identify which type of acne you have in order to choose the most appropriate treatment.
Grade 1: Mild
Mild acne may never progress beyond that stage, or it could be an early sign of a more severe case. This type of acne is non-inflammatory, which means an absence of redness and bumps. For this reason, mild acne is sometimes referred to as “flat” acne.
Grade 1 acne is characterized by the appearance of open comedones, or blackheads. These blemishes occur when pores are clogged by an excess of waxy sebum, which is an oily substance secreted to lubricate skin.
Blackheads are mistakenly believed by many people to get their color from dirt trapped in the sebum. It actually results from oxidation at the point where the sebum is exposed to the air. They can appear anywhere on the face, but they are usually found in the T-zone of forehead, nose and chin.
Over-the-counter products are generally sufficient to treat mild acne. Look for water-based products with salicylic acid, which is effective for unblocking pores. Steaming is also a good method to open and clear pores.
Grade 2: Moderate
In moderate acne, blemishes appear in greater numbers. It’s marked by the presence of whiteheads, which are closed comedones that may have some slight swelling with mild inflammation showing as well. Blemishes are more likely to appear randomly across the face rather than only in the T-zone.
With Grade 2 acne, there will also be occasional papules and pustules, which are the types of blemishes that most people associate with acne.
- Papules are raised red bumps caused by bacteria that have damaged the pore with no fluid inside. Unlike mild acne that remains in the outer layer of skin, papules may originate deeper inside the dermis. Papules can sometimes develop independent of acne, creating uncertainty about the actual condition of the skin.
- Pustules are also raised red bumps, but present as white at the top due to an accumulation of white blood cells and debris.
While papules and pustules indicate the presence of bacteria, the inflammation is actually due to the immune system’s response to the infection.
You should strongly consider topical treatments that will cleanse the skin and destroy the bacteria, but can also maintain proper moisture levels. Skin requires oil to stay soft and lubricated, so the goal of treatment is to subdue the inflammation, not strip your face of oil.
Grade 3: Severe
Acne moves to Grade 3 when blemishes occur in larger numbers and inflammation is more pronounced. Blemishes may be so dense that they spread and merge together, resulting in an entire area of skin being infected rather than just a single pore. When it reaches this point, the skin’s structure is compromised, opening up the possibility of acne scarring.
Since the infection extends more deeply into the skin, abrasive exfoliants should be avoided since they are more likely to spread the infection rather than relieve it. Dermatologists, who can prescribe medicinal treatments including topical and oral antibiotic treatments to reduce inflammation, should usually be consulted prior to treating grade 3 acne.
With a greater incidence of papules and pustules comes a greater temptation to eliminate them by squeezing or popping. Unfortunately, this can serve to spread the bacteria and multiply breakouts. The greater danger is that squeezing can actually aggravate the infection by forcing the infection deeper into the skin.
Grade 4: Cystic
In Grade 4, cystic acne is characterized by large, angry-looking blemishes on the face and jaw line which can also affect the upper body, neck, arms, shoulders and back.
- The aggravated nature of Grade 4 acne often results in cysts, which are deep blemishes more than 5 mm in diameter. Their appearance is similar to that of a boil, with a smooth, tender surface that is painful to the touch.
- Nodules are hard, painful bumps that are similar to cysts but contain no pus or other fluids. They can last for weeks or months and even go dormant only to reappear later on.
Due to the severity of Grade 4 acne and the depths to which it extends, scarring is a very real possibility and should be treated by a dermatologist to minimize scarring and long term damage. In addition to prescription-strength topical treatments and oral medications, dermatologists may inject corticosteroids directly into larger cysts and nodules.
Even mild acne can be enough to affect your quality of life by damaging your self-esteem and causing you to avoid social situations. No matter what type of acne you have, you don't have to resign yourself to living with it.