From the Guidelines
Acne is typically categorized into four main types based on severity and characteristics: comedonal, inflammatory, nodular, and cystic acne. Comedonal acne is the mildest form, characterized by non-inflammatory blackheads and whiteheads caused by clogged pores. Inflammatory acne presents as red, swollen papules and pustules due to bacterial infection and inflammation of clogged follicles. Nodular acne involves deeper, painful bumps under the skin that can last for weeks or months. Cystic acne is the most severe form, featuring large, painful cysts deep within the skin that can cause scarring.
Treatment Approaches
Treatment approaches vary by type, with comedonal acne often responding to topical retinoids like adapalene 0.1% or benzoyl peroxide 2.5-5% 1. Inflammatory acne may require these plus topical antibiotics like clindamycin 1%. Nodular and cystic acne typically need oral medications such as antibiotics (doxycycline 100mg twice daily for 3 months) 2, hormonal treatments (spironolactone 50-100mg daily for women) 3, or isotretinoin (0.5-1mg/kg/day for 4-6 months).
Key Considerations
These categories help dermatologists determine appropriate treatment strategies, as more severe forms require more aggressive interventions to prevent scarring and reduce inflammation. The use of topical therapies combining multiple mechanisms of action is recommended as a good practice statement to optimize efficacy and to reduce the risk of antibiotic resistance 1. Limiting systemic antibiotic use and combining systemic antibiotics with benzoyl peroxide and other topical therapies are also recommended as good clinical practices 2.
Recommendations
The most effective treatment approach is often a combination of topical and oral medications, tailored to the individual patient's needs and acne type. For patients with severe acne or for patients who have failed standard treatment with oral or topical therapy, isotretinoin is recommended 3. Population-based studies have not identified increased risk of neuropsychiatric conditions or inflammatory bowel disease in acne patients undergoing treatment with isotretinoin 3.
Summary of Recommendations
- Comedonal acne: topical retinoids or benzoyl peroxide
- Inflammatory acne: topical retinoids, benzoyl peroxide, and topical antibiotics
- Nodular and cystic acne: oral medications such as antibiotics, hormonal treatments, or isotretinoin
- Severe acne: isotretinoin
- Limiting systemic antibiotic use and combining systemic antibiotics with benzoyl peroxide and other topical therapies are recommended as good clinical practices 1, 2.
From the Research
Categories of Acne
- Acne can be classified based on the number and type of skin lesions, as well as the severity of the condition 4
- The main categories of acne are: + Mild acne: characterized by a small number of comedones (blackheads and whiteheads) and inflammatory lesions 4, 5 + Moderate acne: characterized by a larger number of comedones and inflammatory lesions, with possible scarring 4, 5 + Severe acne: characterized by a large number of inflammatory lesions, nodules, and cysts, with significant scarring 4, 5
- Acne can also be classified based on lesion morphology, including: + Comedonal acne: characterized by open and closed comedones (blackheads and whiteheads) 5 + Inflammatory acne: characterized by papules, pustules, and nodules 5 + Mixed acne: characterized by a combination of comedonal and inflammatory lesions 6, 5 + Nodulocystic acne: characterized by large, painful nodules and cysts 5