The 4 Stages of Acne – What are They and Treatment

Skin problems like acne are common; most people, at some time, will suffer from it. It is most often seen in teenagers and even adults, but mostly teenagers are involved in this problem. Although most people tend to associate acne with the presence of “severe acne,” there are various types with different levels of severity. Understanding the symptoms of each type can help individuals find the right treatment.

This blog post outlines the four stages of acne severity. From it, you’ll learn how each of the stages of acne is identified so that appropriate treatment can be executed.

The Four Stages of Acne

Four stages can be noted with acne: mild, moderate, moderate to severe, and severe (cystic acne), graded from 1 to 4. Before we get to the four stages of acne, first, let’s get to know what acne is, its cause, and how to identify each stage accordingly.

Acne 101 – A Brief Overview

Acne is a prevalent skin issue that occurs when hair follicles become blocked with dead skin cells and oil. It is often referred to as pimples, blackheads, and whiteheads, but medically, acne is described as a condition of the skin that occurs when oil and dead skin cells plug hair follicles. It typically appears on the face, neck, chest, and shoulders. [1]

It’s most common among teenagers but may affect babies, children, and adults at the age of 12 up to the age of 25; however, it can happen to people at any age. [2] At times, people with acne feel so embarrassed that they may skip socially important activities, such as school. Teenagers should therefore seek help early to avoid physical and social problems related to acne.

Causes of Acne

The main cause of acne is overactive sebaceous glands. It is non-contagious, as therefore one cannot acquire it from other people. Sebum under the skin is produced from sebaceous glands; sebum enables the skin to be soft.

During puberty, there are hormonal changes that cause these glands to produce more sebum, hence increasing the chances of acne. [3]

Other Common Causes of Acne

Here are some other common causes of acne:

• Hormonal changes: Increased oil production in the skin may be due to some hormonal changes that, in turn, more than regular, stimulate the sebaceous glands.
• Hereditary: Acne can run in families, although it’s not contagious. [4]
• Food allergies: Certain foods can trigger acne in some individuals, such as milk, biotin, dairy, gluten, soy, and sugar.
• Irregular facial cleansing: Not removing dead skin regularly can clog pores.
• Cosmetics: Using new or unsuitable products can cause breakouts. This includes makeup, sunscreen, and products with pore-clogging ingredients or irritating fragrances.
• Lack of sleep and stress: It can overstress acne symptoms, though it doesn’t directly cause pimples. Lack of sleep can also aggravate acne.
• Underlying health problems: Conditions like thyroid problems, PCOS, digestive issues, and metabolism imbalances can contribute to acne. [5]
• Build-up of Toxins: Toxins accumulating in the body can lead to acne breakouts.

Stages of Acne

Acne has four stages or grades based on its appearance and severity. It may vary from person to person. This classification helps understand the type of acne and find the right treatment to speed up the healing process.

There are four grades of acne:

1. Grade 1: Mild Acne
2. Grade 2: Moderate Acne
3. Grade 3: Moderate to Severe Acne
4. Grade 4: Severe or Cystic Acne

Once you recognize the appearance of your acne, it’s easier to determine which grade you’re in and find the best treatment option.

Grade 1: Mild Acne

This grade is the mil form characterized by few comedones (blackheads or whiteheads). It is common, and most people around the world do worry about it. Grade 1 acne may refer to one with non-inflammatory features, which normally include mainly blackheads and few papules that are small and red and often located on the face. [6]

These breakouts are slight and occasional. The appearance of Grade 1 Acne is generally not painful or very visible but can pose cosmetic concern and insecurity.

Mild Acne Treatment

Home remedies for mild acne include:

• Cleansing with a good skin cleanser twice daily in circular motions to remove excess oil.
• Occasional use of skin exfoliating gels to remove dead skin and unclog pores.
• Using acne gel with Azelaic acid or Salicylic acid on pimples to speed up healing.
• Steam inhalation before using skin exfoliating products for better results.
• Using a blackhead extractor or removal tool to remove deep-rooted blackheads, preventing further development.

It’s important not to squeeze pimples, as it can damage the skin and cause inflammation, redness, and sometimes infection.

Mild acne can often be treated with OTC topical treatments containing:

• Benzoyl Peroxide: Eradicates acne-causing bacteria and unclogs pores. [7]
• Salicylic Acid: Exfoliates skin and unclogs pores. [8]
• Retinoids: Prevents the dead skin cells buildup.

Grade 2: Moderate Acne

Moderate acne presents with blackheads, pustules, bumps, and pimples on the skin, with more blemishes than mild acne. [9] Pimples can occur on the face, not just in the T-zone area, and may spread to some connected areas like the neck, shoulders, chest, and back.

Whiteheads, or closed comedones, are raised yellowish dots that release white material when squeezed. Breakouts may occur more frequently and often display redness or inflammation.

Treatment of Moderate Acne

Managing Grade 2 or moderate acne can be more challenging compared to Grade 1. Home remedies include:

• Cleanse your face twice daily and gently pat dry.
• Avoid using exfoliating face scrubs, as they can damage the skin further.
• Use oil-controlling cleansers twice daily to wash your face and affected areas, and softly pat dry.
• Apply OTC face creams on pimple heads twice daily.
• Refrain from squeezing or picking pimples, as it can worsen skin infection and scarring.

Over-the-counter topical treatments can be helpful, but sometimes more potent preparations are needed. [10] These may include:

• Topical Antibiotics: These are applied to decrease inflammation and combat bacteria.
• Topical Retinoids: Retinoids with higher concentrations have the ability to improve cell regeneration.
• Azelaic Acid: It aids in reducing inflammation, eliminating bacteria, and clearing clogged pores.[11]

Continue OTC treatment for at least a month to treat acne. If there’s no improvement or if the condition worsens, consult a professional medical practitioner or dermatologist for further assistance.

Grade 3: Severe Acne

The third stage represents the beginning of an inflammatory process. There appear many pustules and pimples on the skin of the face. Besides, some nodes and cysts may appear. Quite often, the described lesions are close to each other, which causes them to spread, thus forming a kind of cluster. This can result in scarring.

For more severe acne, the infection goes deeper into the skin, increasing redness on the face along with mild swelling. It produces outbreaks more often and with more likelihood of spreading to the neck and chest. These can have a more red appearance and be tender to the touch.

Treatment of Severe Acne

For effective control of severe acne, it’s advisable to consult a dermatologist rather than relying solely on topical treatments. Some common options of prescription topical or oral medicine to treat acne include:

• Topical Retinoids: Retinols, available over the counter, work to eradicate dead skin cells, enhance cell turnover, combat bacteria, reduce inflammation, and clear pores. [12]
• Oral Antibiotics: Antibiotics, whether oral or topical, are typically used for severe inflammatory acne to target bacteria and expedite breakout healing. However, long-term use of antibiotics is discouraged due to the risk of developing resistance.
• Oral Contraceptives: Certain contraceptives may help balance the hormone levels in women, thereby reducing acne.

In addition to medication, maintaining proper local hygiene is crucial:

• Keep the skin clean.
• Avoid squeezing or picking pimples.
• Use medicated oil-controlling face cleansers.
• Minimize exposure to dust and sunlight.
• Avoid unnecessary touching of the face to prevent spreading infection and worsening acne.

Grade 4: Cystic Acne

Grade 4 is very severe and is characterized by large sores, which are extremely painful. It may occur on the face, shoulders, neck, and back. They are firm and deep to the touch, resembling boils or large blisters, with a diameter of less than a centimeter. Cysts, which contain pus, are common in this stage.

Treatment for Severe Acne

Treating severe acne, especially for sensitive skin, requires extra care and aggressive measures to prevent scarring. It may include:

• Oral Antibiotics: These are still an option for severe acne. Common antibiotics like minocycline may be prescribed by a dermatologist. Treatment typically lasts for 3-6 months and requires patience and compliance. [13]
• Isotretinoin: Severe inflammatory acne cases may require Isotretinoin, an oral medication often prescribed for severe, resistant acne. It’s effective but can have side effects and needs careful monitoring by a professional.
• Oral Contraceptives: In female patients, birth control pills can help manage hormone-related acne.
• Steroid Injections: A dermatologist may administer these directly into bumps to decrease inflammation.
• Combination Treatments: Antibiotic gels, retinoid gels, or combinations may be prescribed for topical application.

In addition to medical treatment, following basic skin hygiene steps is crucial:

• The doctor prescribes cleaning the face twice daily with medicated cleansers suitable for oily skin.
• Avoid squeezing lesions or using harsh scrubs for exfoliation.
• Control excessive oil production by using oil-free cleansers.
• Refrain from using skin-exfoliating products.
• Avoid harsh skincare products like scrubs, exfoliants, makeup products, and soaps.

Cystic acne is challenging to treat and may require ongoing management and regular follow-up visits to the dermatologist to prevent future recurrences.

8 Signs that Acne is Healing

It is sometimes distressing to know when acne is at the healing stages. Although not every person will have the same process of healing, there are certain cystic acne healing stages which indicate healing has occurred: 

1. Crusting of the cysts and pustules: By this time, crusting of the larger cysts and the smaller pustules begins to occur, showing that the treatment is beginning to control the acne.
2. Shrinking of pimples: With time, the pimples may actually decrease in size as inflammation subsides. They will be considerably fewer and less protruding from the skin.
3. Nodules diminish: Hard bumps beneath the skin, called nodules, recede as acne heals, leading to smoother skin texture.
4. Redness reduction: A decrease in redness signifies that inflammation is improving, a positive sign of healing.
5. Decrease in pain or tenderness: The natural healing of acne usually will decrease pain related to the pimple, such as that occurring or found on the skin. The skin feels less sensitive to touch.
6. Less oily skin: Balanced sebum production leads to reduced oiliness, creating less favorable conditions for acne development.
7. Reduction in blackheads and whiteheads: Fewer blackheads and whiteheads indicate a decrease in future acne breakouts.
8. Reduction in frequency of new breakouts: A significant sign that acne is healing is a decrease in the frequency of new breakouts. As existing acne clears up, fewer new pimples tend to appear.

How to Prevent Acne

Preventing acne can be achieved through simple lifestyle changes. Here are some tips:

• Limit consumption of chocolates and sugary foods.
• Reduce intake of dairy products.
• Stay hydrated by drinking lots of water to prevent skin dehydration, which can trigger oil production.
• Manage stress levels by practicing relaxation techniques and ensuring adequate sleep.
• Use moisturizers to keep the skin hydrated, but avoid those containing irritants.
• Use high-quality creams and makeup products suitable for your skin type.
• Thoroughly cleanse your face after using makeup.
• Maintain cleanliness by washing your face two times a day to remove dirt and excess oil.
• Minimize sun exposure and use sunscreen or carry an umbrella when outdoors to prevent skin dehydration.
• Stay patient and avoid panicking if a pimple appears, as it can worsen the issue.

Summing Up!

Acne is a widespread issue that can affect your appearance, but the good news is that it’s manageable. Educating yourself about acne is crucial in tackling this common skin problem. By understanding the various stages of acne, you can assess the severity of your condition and take appropriate steps toward clearer skin.

If you’re unsure about your acne type or stage, just fill out the form at UVTreat, and our experts will assist you in diagnosing your acne and recommending an appropriate treatment based on your skin issue.