Three Stages of Acne and Treatment

When it comes to determining the best, most customized treatment for your acne, it helps to understand the different types of acne and the acne stages: mild, moderate, and severe. While mild cases might go away if you use an over-the-counter (OTC) product, more severe acne might require a prescription medication or procedure.

This article explains the stages and types of acne, how to treat acne, and ways to prevent it.

What Is Acne?

Acne is a common skin condition that occurs when hair follicles under the skin become clogged with dead skin cells and sebum, which is oil that helps keep skin moisturized.

Normally, two processes keep skin acne-free: Sebum travels out of the pore and onto the skin's surface, and skin cells called keratinocytes routinely rise to the surface of the follicle and shed. With acne, however, sebum, hair, and keratinocytes stick together in the pore.

Bacteria that naturally grows on skin thrives inside, causing swelling, redness, and pain that can only become worse if the follicle wall breaks, exacerbating the inflammation.

This process takes one to two weeks and tends to happen more in teenagers and young adults. However, older adults can also have acne.

What Are the Stages of Acne?

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.

Acne

Stage 1: Mild

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. 

Stage 2: Moderate

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.

Stage 3: Severe

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

What Are the Different Types of Acne?

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

The most common type of acne is acne vulgaris, which is your regular, run-of-the-mill acne that is most commonly found on the face, back, shoulders, and buttocks (don't be embarrassed, butt acne is common). If you're breaking out, most likely you have acne vulgaris.

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.

There are several types of acne vulgaris:

• Comedonal acne: This is characterized by bumpiness, blackheads, and milia (small white bumps) rather than inflamed pimples.
• Cystic acne: The most severe form of acne vulgaris, this type can occur anywhere on the face or body and consists of inflammation and large, painful blemishes (or cysts).
• Nodular acne: Another severe type of acne vulgaris, breakouts are made up of large, hard, and deep blemishes called nodules.

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 appears 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 they have it. But it can progress to more severe forms, causing an inflamed, bulbous nose, and even eye problems if the eyelids swell, 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.

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.

Don't be ashamed, but do talk to your healthcare provider. They can help you with the drive that's causing skin picking.

How Is Acne Treated?

Acne treatment depends on the specifics of the condition.

The good news is mild acne can often be treated with OTC products, such as:

• Benzoyl peroxide: This substance is in cleansers, lotions, and creams, and works by killing Propionibacteria acnes, the bacteria responsible for acne breakouts.
• Sulfur and resorcinol: They are usually found together in acne products, including Clearasil Medicated Blemish Cream, Clearasil Medicated Blemish Stick, and Rezamid Lotion.
• Salicylic acid: Especially good for blackheads and whiteheads, salicylic acid works by helping the skin to shed dead cells more effectively.
• Alcohol and acetone: These are used in combination with many products to reduce the amount of oil produced, clearing blockages.

If you have moderate or severe acne, you may struggle 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.

One of the most common prescription topical treatments is retinoids, which help keep pores clear and reduce oily buildup. They have some side effects, though, such as dry skin. The other common prescription topical treatment is antibiotic cream, which reduces the bacterial infections that contribute to acne breakouts.

Your dermatologist may also prescribe oral medications to treat moderate or severe acne. They include:

• Antibiotics, which generally start to clear skin in four weeks
• Birth control pills that contain estrogen, which are helpful if you tend to break out during your period
• Isotretinoin, an oral retinoid formally known as Accutane

If these treatments don't work, a dermatologist may recommend in-office procedures, such as:

• Corticosteroid injections, which target deeply rooted pimples
• Chemical peels, which typically use concentrated glycolic acid to strips layers on the skin, clearing blackheads and whiteheads
• Laser and light-based therapies, which target discoloration or scarring from acne

As acne heals, it will feel less painful and appear less red and inflamed. Once it goes away, you may notice that it's replaced with discoloration. These spots are called post-inflammatory hyperpigmentation and will eventually go away.

How Is Acne Prevented?

While some people might be prone to acne, making it more difficult to prevent, it's still possible to take measures to prevent it from becoming out of control or developing at all. Prevention strategies include:

• Washing your face once or twice a day with your fingers and a gentle cleanser
• Avoiding face products like astringents, toners, and exfoliants, which can make acne appear worse
• Using face products that are "alcohol-free"
• Washing your hair regularly to prevent the oil from your head from causing a breakout on your forehead
• Keeping your hands off of your face
• Avoiding tanning beds and, if you can, the sun

What Conditions Are Confused for Acne?

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.

Some conditions that are often confused for acne include:

• Folliculitis, a condition in which the hair follicle is inflamed and bumps or pustules may result
• Keratosis pilaris, which is a rash characterized by small, rough, "goose-flesh" like bumps most often found on the upper arms, thighs, and buttocks
• Miliaria rubra, also known as heat rash
• Steroid acne, a rash that is caused by taking oral steroids such as prednisone

Summary

Knowing your acne type and the stage of your acne—mild, moderate, or severe—can help you know how to treat the condition. While mild acne can typically be treated with OTC products, moderate or severe acne may require prescription topical or oral treatments, such as antibiotics. In very severe cases, your dermatologist may recommend injections, chemical peels, or laser or light therapies. Washing your face regularly with a gentle cleanser can help prevent acne.