What Is Considered Severe Acne?

The types of acne lesions may include

• Comedones (whiteheads or blackheads) or papules: These are basic acne lesions that are plugged pores. If a plugged pore stays under the skin, it's called a closed comedo and it forms a white bump or whitehead. Blackheads are comedones that open and appear blackish on the skin surface. This black color is not because of dirt but because air reacts with excess oil.
• Pustules or pimples: They are acne lesions that contain pus and are red at the base.
• Nodules: These are more serious acne lesions. They lodge deeper in the skin, are painful and can cause scarring.
• Cysts: Like nodules, these lesions are deep within the skin, are painful and filled with pus and can cause scarring.

Understanding the grade of acne can help people choose the course of treatment that will be most effective. It will help them select products. It will help them decide if they can treat their acne at home or if they should see their dermatologist.

Grade I

• It is the mildest form of acne. There may be minor pimples, but they will be small, appear only very occasionally and in small numbers (one or two). People will find blackheads, sometimes in great numbers, but there is no swelling.
• It is commonly seen in early adolescence, especially on the nose and/or forehead.
• Many adults also experience grade I acne as blackheads on the nose and forehead.
• It can be successfully treated at home using an over-the-counter product containing salicylic acid.

Grade II

• It is considered moderate acne.
• There will be blackheads generally in greater numbers. People will start seeing more papules and the formation of pustules in this stage. 
• Blackheads will appear with higher frequency, and general breakout activity will be more obvious. Slight swelling of the skin is now apparent.
• People may see the acne progress from the nose and forehead to other areas of the face. Acne may start to affect the chest and shoulders, with occasional breakouts on the back, especially in men. Adult women may find higher breakout activity in the cheeks, chin and jawline area, especially just before and during the menstrual cycle.
• Grade II acne can still be treated at home using over-the-counter products. In addition to salicylic acid, people should use benzoyl peroxide lotion daily to help kill the bacteria that cause inflamed breakouts.

Grade III

• This type of acne is considered severe.
• The difference here is the amount of inflammation present. The skin is now obviously reddened and inflamed.
• Papules and pustules have developed in greater numbers and nodules will be present.
• Grade III usually involves other body areas such as the neck, chest, shoulders and/or upper back, as well as the face. The risk of scarring becomes higher because the infection spreads and becomes deeper.
• A dermatologist should treat acne at this stage. Grade III acne is usually treated with both topical and systemic therapies such as antibiotics available only by prescription.

Grade IV

• It is the most serious form of acne and is often referred to as cystic acne.
• The skin will display numerous papules, pustules and nodules, in addition to cysts.
• There is a pronounced amount of swelling and breakouts are severe. Cystic acne is very painful.
• Acne of this severity usually extends beyond the face and may affect the entire back, chest, shoulders and upper arms. The infection is deep and widespread. Nearly all people with cystic acne develop scarring.
• A dermatologist must treat grade IV acne. Grade IV acne tends to be hard to control and almost always requires powerful systemic medications in addition to topical treatments.

Being able to identify different types of acne is crucial when defining skin care goals. Knowing the lingo not only makes it easier for people to choose the right home care products, but also makes it helpful when developing a treatment plan. To ensure you’re ready to communicate your skin care concerns, learn all about the differences between pustules and papules and best ways to treat the most common types of acne.