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Grade I acne is the mildest form of acne. There may be minor pimples but
they will small, appear only very occasionally, and in small numbers
(one or two). Blackheads and milia will be found, sometimes in great
numbers, but there is no inflammation of Grade I acne.
Grade I acne is commonly seen in early adolescence, especially in the
nose and/or forehead. Many adults also experience grade I acne, as
blackheads on the nose and forehead. Milia are commonly found in the eye
area and chin.
This type of acne can be successfully treated at home using an
over-the-counter product containing salicylic acid. Results generally
are seen quickly. Treating acne while it is still in its early stages
helps prevent acne from progressing, especially in teens. Grade I acne
may progress to Grade II if left untreated.
Grade II is considered moderate acne. There will be blackheads and milia,
generally in greater numbers. You will start seeing more papules and the
formation of pustules in this stage. They will appear with greater
frequency, and general breakout activity will be more obvious. Slight
inflammation of the skin is now apparent.
In teens, you 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 males.
Adult women may find greater breakout activity in the cheeks, chin, and
jaw line 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 a
salicylic acid, a
benzoyl peroxide lotion
should be used daily to help kill the bacteria that cause inflamed
breakouts. However, if after several weeks of home treatment your acne
does not significantly improve, it is time to see a dermatologist. Grade
II acne may progress to Grade III, especially if pimples are habitually
picked at or squeezed.
This type of acne is considered severe. The main difference between
Grade II acne and Grade III 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 chance of
scarring becomes higher as 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 available only
by prescription. Left untreated, Grade III acne may progress to Grade
The most serious form of acne, Grade IV is often referred to as
nodulocystic or cystic acne. The skin will display numerous papules,
pustules, and nodules, in addition to cysts. There is a pronounced
amount of inflammation and breakouts are severe. Cystic acne is very
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 cystic acne sufferers develop scarring.
Grade IV acne must be treated by a dermatologist. It tends to be hard to
control, and almost always requires powerful systemic medications in
addition to topical treatments.
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