Sometimes acne is nothing more than a simple pimple, a bit of trapped pus consisting of sebum, dead skin cells and white blood cells. But it can be more severe. Knowing which type you have is key to a proper diagnosis and treatment plan.

Professionals recommending a course of treatment will rank acne by Grade.

Grade I includes milder, non-inflamed types such as blackheads, whiteheads or milia. Grade II involves a larger number of these, and frequently includes papules or pustules that are mildly inflamed.

Papules are small lesions, a change or break in the skin, that is smaller than 5 mm – about the width of a thin cigarette. They’re in the form of a bump that rises above the surface. A pustule, by contrast, is pus-filled – a mixture of bacteria, white blood cells and dead skin cells.

Grade III is more severe. The papules or pustules will be red, larger and more numerous. Grade IV is the most severe level, and includes nodules and cysts. The inflammation is usually wide spread and includes more than just the face.

Acne vulgaris is the common form of mild acne. Any of the Grade I forms will fall under this heading. They can usually be treated with over the counter medications.

In more severe form acne can develop into a type known as acne congoblata. The name may sound amusing, but the condition is anything but. It’s characterized by heavy inflammation and deep abscesses. The result is often scarring and other forms of serious skin damage.

Inflamed nodules will form around comedones – a general term for blackheads, whiteheads and milia. They often grow until they spontaneously discharge pus. While they do, they’re painful. When they do, they’re unsightly. Keliod-type scars are commonly left behind.

Another type is known as acne fulminans. Here, the nodules will often ulcerate, leading to a painful and recurrent form of acne. The person afflicted may even develop a fever or aching joints. Treatment with corticosteroids or NSAIDs (non-steroidal anti-inflammatory drugs) is usually called for. But these treat symptoms, not the underlying cause.

In still more severe forms, a person may develop nodulocystic acne. Cysts form (red bumps produced by severe inflammation), but they’re of an unusual type. Sometimes they become numerous and close enough together to form a larger inflamed area. When they form small tunnels under the skin, infection can spread more readily. A treatment of antibiotics is called for, and isotretinoin (brand name: Accutane) is frequently employed.

Gram-negative folliculitis occurs when the follicles – the shaft in which hairs grow and sebum flows from the sebaceous glands – become infected. Bacteria grow inside and the body responds by dispatching white blood cells to fight the infection. The result is a deep eruption that calls for special treatment.

The type of bacteria that produces it may be resistant to normal antibiotics. In fact, the condition may have resulted from treatment of other types of acne treated with antibiotics.

Proper diagnosis of these forms of acne calls for a visit to a professional. A dermatologist’s care is warranted in these cases, as it may be in other forms of severe acne.

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