Diagnosing Acne & Acne Severity


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Acne is very easy to recognise and is diagnosed by a doctor or dermatologist simply examining your skin. You can perform this examination yourself, although if you have any concerns about your acne or any uncertainty regarding your diagnosis or believe that your condition is moderate-to-severe it is important to consult a professional.

How To Recognise Acne

This section relates specifically to the most common variety of acne, acne vulgaris, although most other strains of acne share the same characteristics. Acne is characterised by the emergence of whiteheads, blackheads and raised 'spots' of which there are four kinds: papules, pustules, nodules and cysts.

These blemishes more frequently appear on the face but can also emerge on the rest of the body. The most common areas affected by body acne include: the neck and upper back, the upper arms, the chest, the buttocks and the thighs.

Types of Spots

  • Papules – Raised red lumps caused by the initial introduction of white blood cell enzymes through a break in the wall of a pore.
  • Pustules – Raised red lumps with a yellow head or centre otherwise known as a zit or pimple. These are the result of white blood cells in a papule reaching the surface of the skin.
  • Nodules – Larger, sore red lumps that occur after the complete collapse of a follicle due to the release of a white blood cell’s enzyme. This results in a large, painful inflammation that can spread to neighbouring pores.
  • Cysts – Larger, more painful, pus-filled lumps that are a more serious form of an inflamed nodule.

Acne Severity

Often during diagnosis, your doctor or dermatologist will assess the severity of your acne using a system that puts your condition into one of four grades. These grades allow your practitioner to provide the best treatment for your personal condition. They work as follows:

  • Grade One – This is the mildest form of acne vulgaris. It includes whiteheads and blackheads and very occasional papules. This grade of acne can be treated at home without prescription medication although, in younger sufferers, it can be the starting point for more serious acne.
  • Grade Two – This grade describes moderate acne. This severity includes a much higher number of whiteheads. More blackheads will also be visible and a few papules and pustules might be present. At this level over-the-counter medication and home treatment may be effective however, consultation with a doctor or dermatologist is necessary if non-prescription treatments have little effect after 4-6 weeks.
  • Grade Three – This is the level of acne many people associate with teenage skin. The area will be visibly irritated and red with a much higher occurrence of papules and pustules, possibly with some nodules also appearing. At this level it is highly recommended that you consult your doctor or dermatologist as this grade of acne could cause scarring. In these cases, prescription medicine is generally required.
  • Grade Four – This is the most severe form of acne, it is also known as severe or cystic acne and includes all of the typical acne features: blackheads, whiteheads, papules, pustules, nodules, cysts, skin inflammation and irritation. This grade of acne must be treated by a qualified practitioner, as it can result in serious scarring, depression and physical discomfort. Usually you will be prescribed an oral medication as well as topical creams to apply to your acne.

Acne Misdiagnosis

Although acne is very easy to recognise there are a few skin conditions that look similar. It is important, therefore, to consult your practitioner if you are at all unsure about your skin complaint in order to make sure you are getting the correct treatment. The most common confusion occurs with Acne Rosacea, which exhibits many of the same features of regular acne but requires completely different treatment. It is possible to tell the difference. Rosacea includes papules and pustules but, unlike normal acne, it does not form blackheads. Other conditions that are sometimes misdiagnosed as acne include heat rash, Perioral Dermatitis, Keratosis Pilaris and Folliculitis


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