As June is Acne Awareness Month, we at Facethetics wanted to educate you more on the various types and grades of acne and how to manage it.
Firstly, it’s important to understand that acne is an inflammatory skin condition of the pilo-sebaceous unit, that can begin in adolescence or adulthood. Adolescent acne is caused by the increase of androgen hormones during puberty. This can result in the sebaceous glands producing excess oil called seborrhoea. It appears as pustules and papules on the skin, although sometimes dermal inflammation and painful cysts can also occur. This type of acne is known as acne vulgaris.
Acne rosacea is another type of acne that is characteristically more inflamed and vascular along the cheeks, nose and chin, with papules and pustules present in severe cases. An increase in skin temperature stimulates the production of sebum and gives the skin a ‘flushed’ appearance around the cheeks, chin and nose area. The skin can also look dry and flaky in places. Spicy foods, alcohol, smoking, strong coffee and exposure to extreme environments of hot and cold are the main stimulants of this skin condition.
Acne grades
Acne is graded 1-5 with grade 5 being the most severe cystic form.
Grade 1: This is known also as comedogenic acne and is the mildest form of the skin condition. It consists of open and closed pores on the forehead, chin and nose. No inflammation is evident, but the t-zone may appear oily or shiny.
Grade 2: Acne is classed as grade 2 if there are 10 or more of each lesion present in the skin. These include; some pustules, papules, as well as open and closed comedones. These will be mainly situated in the t-zone area with the cheeks being relatively clear.
Grade 3: This form of acne is most common in teenagers and those in their early 20s. Its characteristics include papules, pustules in the t-zone area and possibly spreading onto cheek area, chest and back. Skin will appear to have open comedones due to hyperkeratinisation and a sluggish thickened appearance. Oxygenation loss causes the sebum to be thicker.
Grade 4: A combination of grades 1-3 are present here and spread all over the face with some of the papules being of a deeper, nodular type and very painful. A GP or dermatologist prescription will be required to reduce the inflammation prior to clinical treatment.
Grade 5: This is the most severe form of acne and is influenced predominantly by hormonal activity. This condition must be treated progressively not aggressively in clinical treatment but will always require medical intervention first. It is highly inflamed and chronic. Nodules, cysts and occasionally abscesses will be present among papules and pustules. Typically, it affects the face, chest, back, neck and shoulders and leaves pitted scarring in those areas.
Treating acne with chemical peels
As explained above, acne has several grades, which require different approaches when treating. Luckily peels vary in strength and percentage so they can be adapted to treat both mild and deep skin conditions. Salicylic and mandelic acid peels will be ideal for acne grades 1-3 as they are lipid soluble and will aid in the break down and elimination of keratinised cells whilst being anti-inflammatory and antiseptic. For acne grades 4-5, medical grade peels will be required due to the possibility of infection, inflammation and possible deeper cystic conditions present.
Acne scars and how to treat them
Acne scarring presents itself in three ways on the skin and glycolic acid, lactic acid or a Jessner peel would be the best approach to promote a healing response.
Ice pick scar. This is the deepest type of scar, caused by an acneic cyst damaging the tissue as it passes through the skin. It is narrow and can be mistaken for an open pore. Medical grade peeling is the only peel to treat this extensive scar.
Boxcar scar. These are crater-like scars where collagen in the dermal tissue has been damaged by inflammation. Medium or deep peels are best to treat this scarring as the skin will appear uneven and pitted. Minor box scars are usually caused by clients picking the wound before it has fully healed.
Rolling scar. This is the thickest scar, caused by fibrous tissue forming between the dermis and subcutis, which results in puckering of the epidermal tissue. The skin appears lumpy but has a smooth pore texture.
Microneedling is a fantastic treatment to re-educate and stimulate the dermis and collagen fibres to soften the scarring caused by acne. It stimulates collagen type III to effectively produce brand new collagen type I.
Ensuring that your patient has a good skin care regime will aid healing and contribute towards more effective results when being treated in clinic, both when treating the acne itself, as well as any subsequent scarring.
If you'd like to learn more about acne, its causes and how to treat it, Facethetics Training offer a number of skin training courses. Get in touch by giving us a call on 0151 559 0865, or email hello@facetheticstraining.co.uk