Watch: Grade III Acne Follow Up (Video)

First Overview Of Acne

Acne, also known as acne vulgaris, is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin.[10] It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring.[1][2][11] It primarily affects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back.[12] The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.[3][4]

Genetics is thought to be the primary cause of acne in 80% of cases.[2] The role of diet and cigarette smoking is unclear, and neither cleanliness nor exposure to sunlight appear to play a part.[2][13][14] During puberty, in both sexes, acne is often brought on by an increase in hormones such as testosterone.[5] A frequent factor is excessive growth of the bacterium Propionibacterium acnes, which is normally present on the skin.[5]

Many treatment options for acne are available, including lifestyle changes, medications, and medical procedures. Eating fewer simple carbohydrates such as sugar may help.[7] Treatments applied directly to the affected skin, such as azelaic acid, benzoyl peroxide, and salicylic acid, are commonly used.[8] Antibiotics and retinoids are available in formulations that are applied to the skin and taken by mouth for the treatment of acne.[8] However, resistance to antibiotics may develop as a result of antibiotic therapy.[15] Several types of birth control pills help against acne in women.[8] Isotretinoin pills are usually reserved for severe acne due to greater potential side effects.[8] Early and aggressive treatment of acne is advocated by some in the medical community to decrease the overall long-term impact to individuals.[4]

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In 2015, acne was estimated to affect 633 million people globally, making it the 8th most common disease worldwide.[9][16] Acne commonly occurs in adolescence and affects an estimated 80–90% of teenagers in the Western world.[17][18][19] Lower rates are reported in some rural societies.[19][20] Children and adults may also be affected before and after puberty.[21] Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties and a smaller group continue to have difficulties into their forties.[2]

Signs and symptoms


Acne scars are caused by inflammation within the dermal layer of skin and are estimated to affect 95% of people with acne vulgaris.[29] The scar is created by abnormal healing following this dermal inflammation.[30] Scarring is most likely to take place with severe acne, but may occur with any form of acne vulgaris.[29] Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion.[31]

Atrophic acne scars have lost collagen from the healing response and are the most common type of acne scar (account for approximately 75% of all acne scars).[30][31] They may be further classified as ice-pick scars, boxcar scars, and rolling scars.[29] Ice-pick scars are narrow (less than 2 mm across), deep scars that extend into the dermis.[30] Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5–4 mm across.[30] Rolling scars are wider than icepick and boxcar scars (4–5 mm across) and have a wave-like pattern of depth in the skin.[30]

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Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response.[30] They are described as firm and raised from the skin.[30][32] Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders.[30] Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body.[30]


Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions. These lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved. This inflammation stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin’s darkened appearance.[33] People with darker skin color are more frequently affected by this condition.[34] Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule, and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected.[35] Even minimal skin exposure to the sun’s ultraviolet rays can sustain hyperpigmentation.[33] Daily use of SPF 15 or higher sunscreen can minimize such a risk.[35]

Watch: Grade III Acne Follow Up (Video)

Common use of the term “acne” tends to be all encompassing and might include any type of blemish that might affect the skin, primarily on the face. If you have acne, you might think that’s all you need to know.

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But you’ve probably noticed that acne severity varies widely from person to person. Your particular case of acne may even change periodically, depending on conditions like stress and hormone levels.

Actually, dermatologists classify acne into four different types based on form and severity. Understanding the four different types of acne will help you to identify which type of acne you have in order to choose the most appropriate treatment.

Acne moves to Grade 3 when blemishes occur in larger numbers and inflammation is more pronounced. Blemishes may be so dense that they spread and merge together, resulting in an entire area of skin being infected rather than just a single pore. When it reaches this point, the skin’s structure is compromised, opening up the possibility of acne scarring.

Since the infection extends more deeply into the skin, abrasive exfoliants should be avoided since they are more likely to spread the infection rather than relieve it. Dermatologists, who can prescribe medicinal treatments including topical and oral antibiotic treatments to reduce inflammation, should usually be consulted prior to treating grade 3 acne.

With a greater incidence of papules and pustules comes a greater temptation to eliminate them by squeezing or popping. Unfortunately, this can serve to spread the bacteria and multiply breakouts. The greater danger is that squeezing can actually aggravate the infection by forcing the infection deeper into the skin.

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