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You can buy salicylic acid at any drugstore, and it works well for blackheads and the occasional surface pimple, but it won’t do anything for the painful cysts that form deep under your skin and linger for weeks. That’s why dermatologists classify acne by type and severity. Treatment depends on the type of lesions you have and how widespread they are.
At Hines Dermatology Associates in Attleboro, Massachusetts, Yvonne Hines, MD, and our clinical team treat acne at every severity level. Understanding where your acne falls on that spectrum helps explain why some products work and others don’t.
Acne starts when oil, dead skin cells, and bacteria clog your pores. Your skin naturally sheds dead cells and produces sebum to keep the surface moisturized. When those processes go into overdrive or don’t clear properly, the follicle gets blocked.
Once a pore clogs, bacteria that normally live on your skin multiply inside the follicle. Your immune system responds to that bacterial growth with inflammation, which is what creates the redness, swelling, and pain associated with inflamed acne.
Acne presents in different forms depending on whether the clogged pore is open or closed and whether inflammation is involved. Different types of acne include:
Comedones are noninflamed, clogged pores. Blackheads are open comedones where the pore stays open, and the trapped material oxidizes, turning dark. Whiteheads are closed comedones where the pore closes over the clog, creating a small white or flesh-colored bump.
Papules are small, inflamed red bumps that form when the follicle wall breaks down, and bacteria trigger an immune response. Pustules are similar but contain visible pus at the surface. These are the classic red, raised pimples most people associate with acne.
Nodules are large, hard, painful lumps that form deep under the skin when a clogged pore ruptures beneath the surface. Cysts are similar but filled with pus. Both types of lesions are severely inflamed, take weeks to heal, and often leave scars.
Many dermatologists use the IGA (Investigator’s Global Assessment) scale to classify acne based on the types of lesions present and the extent of inflammation. The scale ranges from 0–4 and includes:
Clear skin shows no evidence of papules or pustules. Your skin is completely free of acne lesions.
Almost all clear skin has rare inflammatory papules that are resolving. These papules may be hyperpigmented but aren’t pink or red.
Mild acne presents with a few inflammatory lesions, including papules and pustules. No nodulocystic lesions are present at this stage.
Moderate acne shows multiple inflammatory lesions with many papules and pustules. There may or may not be a few nodulocystic lesions.
Severe acne displays numerous inflammatory lesions with many papules and pustules. There may or may not be a few nodulocystic lesions, and the inflammation is more pronounced.
If your acne isn’t improving with over-the-counter products after a few weeks, or if you’re developing painful nodules or cysts, you need professional evaluation. Waiting too long increases scarring risk and makes treatment harder.
Dr. Hines can assess your acne grade, identify contributing factors like hormones or skincare products, and recommend treatments that match the severity of your condition. Early intervention prevents progression to higher grades and reduces the likelihood of permanent scarring.
Acne severity determines what treatment will work. Mild cases respond to topical care, but moderate to severe acne needs prescription intervention to prevent scarring and long-term damage.
Call our office in Attleboro at 508-222-1976 or book your appointment online today.
