What Are the Types and Stages of Acne?

Treating Acne
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For being such a common skin problem, acne itself can be very complex, from its causes to treatment. You've probably also noticed that everyone's acne is different. That's because there are different types and stages of acne. Acne will even be different at different life periods.

Knowing about your acne type, stage, and severity will help you determine the best, most customized treatment for your skin.

Determining Your Acne Severity

There isn't a universal way to classify acne severity. That means every skin care professional classifies acne in a slightly different way.

Many dermatologists use grades (I through IV, with I being the mildest and IV being the most severe). But the most widely used, and simplest, way of classifying acne is fairly straightforward: mild, moderate, and severe.

There's no test to determine your acne severity. A dermatologist does so by a simple visual inspection of your skin. Your skin can move between these grades because acne tends to wax and wane on its own.

Mild Acne

If your breakouts are few and fairly minor, you've got mild acne. You have some blackheads and bumpiness, and even an inflamed pimple here and there, but in general your blemishes aren't widespread. 

The good news is mild acne can often be treated with over-the-counter acne products.  Mild acne can progress to more severe forms, though, so it's best to treat it early.

Moderate Acne

With moderate acne, breakouts will be more noticeable.  You may still have bumpy skin and blackheads, but you'll also regularly get inflamed papules and pustules

You're probably struggling to get your acne under control with OTC products.  They just aren't strong enough for this type of acne.

Prescription medications are typically needed to clear up moderate breakouts.

Severe Acne

The biggest difference between moderate and severe acne: inflammation. Your blemishes are large, red, and swollen.

If your acne is severe, see a dermatologist. It's more difficult to get severe acne under control, and you'll need a prescription to do so.

Different Types of Acne

Acne isn't just classified by its severity. Did you know there are different types of acne, too? So your acne will fit into several categories, like mild acne vulgaris, or severe acne rosacea. 

Acne Vulgaris

Acne vulgaris is your regular, run-of-the-mill acne. If you're breaking out, most likely you have acne vulgaris.

Acne vulgaris can appear on your face, back, shoulders, and buttocks (don't be embarrassed, butt acne is common!) It can start off mild, but it can progress quickly to more severe forms. That's why dermatologists recommend treating acne vulgaris as soon as you notice breakouts. 

Comedonal Acne

Comedonal acne is a subset of acne vulgaris. Instead of having inflamed pimples, though, you'll have bumpiness, blackheads, and milia. This type of acne can happen anywhere on the face or body, and it can range from very mild to quite severe.

Cystic Acne

This is the most severe form of acne vulgaris. It can occur anywhere on the face or body. With cystic acne, you'll have a lot of inflammation, and large, painful blemishes (or cysts). 

Acne cysts occur deeper in the skin than your typical pimple, take weeks to heal, and can cause a lot of damage to the skin. Because they are so deep, topical acne treatments aren't all that effective. Instead, oral medications like Accutane (isotretinoin) are the best option here.

Nodular Acne

Nodular acne is another severe type of acne vulgaris. Breakouts are large, hard and deep blemishes called nodules.

Many women get a few nodular breakouts just before their monthly cycle. But anyone can get nodular acne, both men and women at any age. Just like with cystic acne, nodular acne should be seen by a dermatologist. If you regularly get nodular breakouts, you will need a prescription acne medication to get them under control.

Acne Rosacea

Acne rosacea is a type of acne that affects adults, usually after the age of 30. It's more common in women, but men tend to get more severe forms. Acne rosacea happens only on the face.

With rosacea, you may get some bumpiness and pimples but you'll notice other signs too: a red, flushed face, and tiny blood vessels on the nose and cheeks. Stress, sun exposure, eating spicy foods, or drinking hot liquids can make your symptoms worse.

Those with mild rosacea may not even know that have it. But it can progress to more severe forms, causing an inflamed, bulbous nose, and even eye problems, so it's best to be checked out by a dermatologist.

Acne Mechanica

Acne mechanica is a type of acne that's caused when there is excess heat, pressure, or friction on the skin. This type of acne is most common on the body but can occur on the face, too.

It's sometimes called sports acne because it's common in young athletes, thanks to helmets, athletic pads, and sweatbands. Anything that traps heat and rubs against the skin can trigger acne mechanica.

Mild acne mechanica can be treated with OTC products, while more severe forms should be seen by a dermatologist. This type of acne can clear itself, too, once the offending trigger is taken away. 

Acne Cosmetica

Cosmetica sounds a lot like cosmetics, so you can probably guess what triggers this form of acne. Products like makeup, creams, and moisturizers, and even certain hair care products cause this type of facial acne.

Acne cosmetica is a type of comedonal acne. It's treated with your typical acne products. You'll also have to stop using the offending cosmetic or hair product to really see improvement of the skin.

Excoriated Acne

Everyone has, at some point, picked at a pimple. People with excoriated acne chronically and excessively pick at pimples (or even healthy skin) to the point of causing wounds.

Does this sound like you? Don't be ashamed, but do talk to your doctor. He can help you so you don't feel driven to pick at your skin anymore.

Acne Look-Alike Conditions

Acne isn't the only skin problem that can cause pimples. There are many other skin conditions that cause pimples, red bumps, or whiteheads on the skin. Be especially wary if your "acne" appears in odd places, like your legs, armpits, scalp, hands or feet, stomach, or pubic area. Acne vulgaris doesn't develop in those areas.

Even if breakouts are in the typical acne zones (face and neck, back, shoulders, buttocks) if you're not 100 percent sure what you're seeing is regular acne, make an appointment with your physician for a diagnosis.

A Word from Verywell

To get your acne treated successfully, you must know what you're dealing with. Most of the time you can get mild acne vulgaris under control with acne products from the drugstore. Acne of any other type or severity though warrants a trip to the dermatologist.

Don't think that acne is just a teen problem, either. Although acne is most common in the teen years, it can occur at any time of life, from birth to well into adulthood. Interestingly, acne is different at different life stages and needs age-specific treatments too. Again, your dermatologist will help you devise an effective treatment plan for your acne type.

Sources:

Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, et. al. "Guidelines of Care for the Management of Acne Vulgaris." Journal of the American Academy of Dermatology; 2016. 74(5):945-73.

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