Acne is easy to diagnose. It is the only skin disease in which
comedones are present. Other skin diseases, such as rosacea
and skin rashes caused by allergies or insect bites, may have red lesions
that resemble papules, but there is an absence of comedones.
Therefore, the presence of comedones, whether alone or in combination
with other skin lesions, indicates the presence of acne.
Treatment to Fit the Type and Severity of Acne
Once acne is diagnosed, the doctor evaluates the type and severity of
a patient’s lesions in order to determine what treatment is best. Acne
treatment is individualized. It depends on the type of acne a person
has as well as how severely acne lesions are inflamed. For example,
treatment for whiteheads and blackheads focuses on removing dead
skin cells that clog the follicles, while treatment for pustules is aimed
at destroying infection and reducing inflammation. In an effort to
achieve these different goals, different medications are needed.
The Acne Scale
To ensure that each patient receives the most effective treatment
for his or her individual problems, doctors employ a special scale
known as the acne grading scale. The acne grading scale rates the
severity of acne on a scale from zero to eight, with zero indicating
very mild acne and eight indicating very severe acne. For example,
if a patient has a few comedones, he or she is given a zero
rating. The rating increases with the number, size, and severity of
a person’s lesions.
Therefore, a patient with half of his or her face covered with papules, comedones, and a few pustules receives a
four rating, which denotes moderate acne. A rating of eight indicates
very severe acne, with the patient having acne lesions of
all types, including numerous cysts, covering almost all of his
or her face. Once a person’s acne has been rated, doctors match
the rating to specific treatment plans recommended by the American
Academy of Dermatology, an organization that studies skin diseases.
At the same time, the doctor makes adjustments in the
recommended treatment for individual differences. For example,
these differences may include such factors as how dry or oily the patient’s
skin may be, the patient’s gender, whether the patient is allergic
to any medications, and whether the patient is pregnant or
planning to become pregnant soon.
