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Acne Severity

Acne is a disease of the hair follicles. It is a very common skin disorder, affecting around 85% of teenagers worldwide. While the disease is most commonly associated with adolescence, it can affect anyone at any age. The average acne sufferer first seeks therapy at the age of 24.

Medically, acne vulgaris is the most common variation of acne. A pleomorphic inflammatory disorder centered on the face, it may spread to the neck, chest and back areas depending on the disease’s type and severity.


Androgens stimulate sebocytes and follicular keratinocytes. A hypersensitivity to this stimulation results in sebaceous gland hyperplasia and seborrhea, which in turn manifests in the form of acne. Other factors that cause the various types of acne include heightened cornification of the ducts, colonization of the follicles by the P acnes bacteria, inflammation, and immune responses.


Acne is characterized by open or closed comedones (blackheads and whiteheads), either individual or grouped with lesions such as papules and pustules. These are found mainly on the face and upper trunk, and their number, type, and distribution determines the severity of the acne.

Acne is not directly life-threatening, but the disfiguration it causes can put sufferers in emotional and psychological distress. Cases of depression, anxiety, and social withdrawal are not uncommon, especially in adolescents.

There are presently many proven and effective acne therapies and treatments available. Appropriate treatment is specific to the acne’s severity and type, as well as the patient’s skin type and medical history. The severity of acne can be graded through more than 25 known methods, and there are 19 methods for counting lesions.

Severity of Acne

Acne vulgaris is easily diagnosed by the presence of comedones, and can be divided into two major types of severity.

  • Inflammatory acne, characterized by the presence of nodules, papules or pustules (having “pus” cells).
  • Non-inflammatory lesions, characterized by open or closed comedones (blackheads or whiteheads).

Acne’s severity may also be categorized in this manner:

Mild Acne can either be mild comedonal acne, where the lesions are mainly non-inflammatory comedones, or mild papopustular acne, where few (ten or less) papules and pustules may be present. Mild comedonal acne may be effectively treated by topical retinoid therapy, while mild papopustular acne may require additional antibacterial preparations and/or acetic acid. Mild acne attacks are mostly limited to the face.

Moderate acne is characterized as having many comedones, a number of pustules, a few nodules, but no scarring. Excessive pigmentation of the skin may also be found on the face, shoulders, back and chest. Oral antibiotics and retinoids are usually prescribed for moderate acne, and women may also opt for hormonal therapy.

Moderately severe acne has erythematous papules, pustules and nodules in moderate distribution on the face, and some scarring may be evident.

Severe Acne. Painful inflammatory nodules may occur anywhere on the body, and the number of papopustules may be too great to count. Scarring is almost certain. Topical and oral antimicrobial agents are often seen as appropriate treatment for severe acne.s

Very severe acne does not clear even with the combination of oral and topical therapy. Sinus tracts, comedone clusters, a great number of painful and deep-rooted nodules, excessive inflamation and inevitable scarring. Patients with excessive seborrhea and/or a gram negative folliculitis infection are most likely to develop very severe acne. Isotretinoin treatment may be prescribed when all other treatment methods have been found ineffective.

Treatment of Severe Acne

Dermatologists know the ins and outs treating the different types of acne, but there is no cure-all for the severe, disfiguring acne. Patients and their families must be aware that the treatment of severe acne may span years, and the results may not always be satisfactory. The support of family and friends will greatly ease the emotional and psychological turmoil that most patients with severe acne undergo.