Jul 20, 2022 · 9 min read
Acne is a common type of skin inflammation that appears when hair follicles clog with oil and dead skin cells. Bacteria and inflammation also play a role. Different types of acne include blackheads, whiteheads, hormonal acne, and cystic acne, and it’s also often broken into different categories: mild, moderate, severe, and very severe. Classifying its severity can help medical providers when prescribing treatments. You might hear acne described as “mild cystic acne” or “mild acne scars,” but what does that actually mean? And what is considered mild acne?
According to the American Academy of Dermatology, there is currently no universally agreed-upon grading system for acne.¹ While there are no set guidelines for categorizing it, we do have some framework that can help you understand where your acne falls on the scale of mild to severe. To help understand the nature of your acne, we’ll primarily look at two factors, the number of acne lesions and the types of acne lesions.
One study formulated a grading system based on the number of acne lesions.² “Mild” indicated one to five blemishes, and “moderate” meant six to 20. A total of 21-50 lesions constituted “severe” acne, and more than 50 meant “very severe.”
Another recent study focused on the types of pimples to determine the level of severity.³ “Mild” indicated mostly comedones such as whiteheads and blackheads, with the occasional papule or pustule. “Moderate” meant more comedones and some papules and pustules. “Severe” indicated a combination of papules, pustules, and nodules.
Remember, there’s no standard rating system that medical providers use to distinguish acne severity, but knowing the basics about the different types of acne can help.
Blackheads are open comedones. Pores are clogged with excess oil and dead skin cells and open to the air.
Whiteheads are closed comedones. Pores are clogged with excess oil and dead skin cells and covered by a thin layer of skin.
Papules and pustules are inflammatory acne lesions. What does inflammatory acne look like? Papules are red bumps and contain no pus, while pustules are filled with pus and have a head.
Cystic acne and nodules often fall into the severe category and are prone to scarring.
Several contributing factors can lead to your mild breakouts. Here are some of them:
Excess oil. Skin naturally produces oil (sebum), in the sebaceous glands, and excess sebum can lead to blemishes when it clogs your pores.
Dead skin cells. These can build up and mix with excess sebum to clog the hair follicles, causing acne.
Bacteria. C. acnes (a type of bacteria that normally lives on) thrives in the excess sebum. This leads to an inflammatory response, signifying that the body’s natural immune system is fighting the bacteria.
Hormones. Whether during puberty or around one’s menstrual cycle, fluctuating hormonal levels can lead to breakouts.⁴
Genetics. Sometimes, it’s written in the stars (or, better said, your DNA). Unfortunately, your tendency to experience breakouts may be tied directly to your family tree.⁵
When over-the-counter treatments aren’t helping, your medical provider may recommend or prescribe different treatments for mild acne, including retinoids, antibiotics, and hormonal medications. It’s important to remember that everyone’s skin is unique, so what works well to treat and help prevent acne for one person may be different for another. And that’s okay! We like to think of skincare as a journey, one that’s best traveled with a little trial-and-error and plenty of patience and TLC. Here are a few treatments that you might come across in your skincare journey:
Retinoids. Topical retinoids are a common treatment for both mild and severe acne. Retinoids can help clear up comedones and reduce the appearance of fine lines. Both over-the-counter options like adapalene and prescription varieties like tretinoin exist.⁶
Topical antibiotics. Another possible topical acne treatment that a doctor may prescribe is a topical antibiotic, such as clindamycin.
Benzoyl peroxide. Benzoyl peroxide is a common active ingredient in many over-the-counter topical treatments and has been shown to be effective in treating acne. It fights the bacteria called C. acnes, which can contribute to acne. Benzoyl peroxide can be found in spot treatments, face washes, and other acne products.
Spironolactone. Spironolactone is an oral prescription medication that can be used to treat hormonal acne in women by targeting androgen hormones.
Salicylic acid. Salicylic acid is another topical acne treatment that, like benzoyl peroxide, is found in many face washes and spot treatments and fights breakouts by unclogging pores.
Hormonal birth control. Some women experience fewer hormonal acne breakouts around their menstrual cycles by taking oral contraceptives.
Isotretinoin. Formerly known by the brand name Accutane, this vitamin A derivative (aka retinoid) is taken orally to treat acne. Medical providers rarely prescribe Accutane for mild acne, as it’s often reserved for more severe cases.
When it comes to options for treating and helping to prevent mild breakouts, many products can help.
Curology Cleanser. The Curology Cleanser is formulated to gently cleanse your skin. It’s perfect for a simple skincare routine because it’s both non-comedogenic and generally safe for sensitive skin.
CeraVe Renewing SA Cleanser. The salicylic acid in this gentle cleanser is a chemical exfoliant designed to fight acne and unclog pores.
Differin Daily Deep Facial Cleanser. This cleanser contains benzoyl peroxide to help treat inflammation and fight C. acnes, the bacteria associated with acne.
La Roche-Posay Effaclar Clarifying Solution Toner. This toner is made with salicylic acid to help remove dead skin cells from the skin’s surface, a simple step you can add to your morning or evening skincare routine. It has alcohol in it, so take care if you have dry or sensitive skin.
Differin Gel. This over-the-counter retinoid, adapalene, may not be as potent as prescription-only varieties. Nevertheless, remember to give your skin time to adjust as you would when introducing any new product, and don’t forget to moisturize.
Curology moisturizer. And speaking of moisturizing, dry skin can easily become irritated and thus more prone to breakouts.⁷ The Curology moisturizer is a great way to keep your skin hydrated and happy.
There are plenty of home remedies for treating acne out there, but at Curology, we’re dedicated to busting as many skincare myths as possible and sticking to research-backed solutions. Here are two DIY treatments that have our seal of approval:
Green tea compress. Green tea is packed with antioxidants that can help with reducing inflammation.⁸ Chances are you probably already have some in your kitchen. If you’re experiencing a pimple that’s inflamed, try brewing yourself a cozy cup of green tea, then let the teabag chill in the freezer for a few minutes, and use it as a cool compress while you sip.
Turmeric. Another common kitchen item, turmeric powder has been used by many cultures throughout history to help various skin conditions. While more research is needed, some promising studies show that turmeric is a powerful antioxidant that can help minimize signs of aging and skin damage.⁹
Let’s be honest. Acne, no matter how mild or severe, can be frustrating. Thankfully, there are many easy ways to treat mild acne and help prevent future breakouts. Here are a few proactive habits you can adopt to help keep blemishes to a minimum.
Wash your face. A simple but effective step to helping prevent acne is washing your face with a gentle cleanser twice daily, in the morning before you begin your day and in the evening right before bed. It’ll help keep your pores clear of excess oil and dead skin cells, reducing the chance of breakouts.
Remove makeup. It might seem difficult (especially after a long day, when all you want to do is fall into bed), but removing your makeup goes hand-in-hand with washing your face to keep your skin free of pore-clogging debris. Our dermatology providers often recommend micellar makeup remover as an option to lift away the day’s waterproof makeup, dirt and oil.
Keep those hands away. Touching your face and picking or popping pimples (as tempting as it can be) can make things worse, as it can cause you to unintentionally spread bacteria or, if you do pop a blemish, push its contents even further into the skin.
Use acne treatments. There are many treatment options for beating breakouts, and finding the right topical application and/or oral medication may help you prevent future ones.
Moisturize. Dry skin can often lead to irritation, which can potentially lead to breakouts. Adding a good face cream to your routine, one that’s non-comedogenic and moisturizing, will help keep your skin happy. If you enjoy the occasional face mask, stick to ones that won’t make you break out.
Speak with a professional. If you are unsure how to start your acne journey, a medical provider may be able to offer knowledgeable guidance regarding your treatment and prevention options.
At Curology, we want to empower you with information for making the best skincare decisions, but we also aim to make dermatologist-designed skincare accessible to everyone. Curology pairs you with a licensed dermatology provider who will help guide you in your skincare journey, and prescribes a custom dermatologist-designed skincare routine delivered right to your door. Not convinced? Check out these before-and-after reviews to see how Curology works.
Curology is one of the easiest ways to get personalized dermatology-backed skincare. Just take a quick skin quiz and snap a few selfies to get paired with a licensed dermatology provider. We’ll take a look at your skin and, if Curology is right for you, send a Custom Formula with a mix of active ingredients chosen for your unique skin directly to your door—for free* (you’ll just cover $4.95 for shipping and handling)—including any of our recommended skincare products at no extra cost. Go ahead, sign up today!
Excess oil. Excess sebum can lead to blemishes when it clogs your pores.
Dead skin cells. These can build up and mix with excess sebum to clog the hair follicles.
Bacteria C. leads to an inflammatory response.
Fluctuating hormonal levels.
Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016).
Hayashi, Nobukazu et al. Establishment of grading criteria for acne severity.The Journal of dermatology (May 2008).
Bernardis, Elena et al. Development and Initial Validation of a Multidimensional Acne Global Grading System Integrating Primary Lesions and Secondary Changes. JAMA dermatology. (2020 March1)
Elsaie M. L. Hormonal treatment of acne vulgaris: an update. Clinical, cosmetic and investigational dermatology. (2016).
Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. (2012 February 18).
Zaenglein A., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016 February 17).
American Academy of Dermatology. 10 skin care habits that can worsen acne.
Katiyar, S. K., Ahmad, N., & Mukhtar, H. Green tea and skin. Archives of dermatology. (August 2000).
Menon, V. P., & Sudheer, A. R., Antioxidant and anti-inflammatory properties of curcumin. Advances in experimental medicine and biology, (2007).
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Nicole Hangsterfer, PA-C