The Grades of Acne chart can aid the professional in determining professional treatments
and appropriate home care for clients.
Descriptions of the Grades of Acne are as follows:
Grade 0 “clogged pores”
Grade 0 is non-inflammatory acne. This client will rarely have pustules or papules,
nodules, or cysts. The skin will be oily, with blackheads that are difficult to
extract. The early-appointment extractions should target only the “cooperative”
ones. Otherwise, it is recommended to wait until the client has been on a home care
regimen for at least two weeks for any extraction facials.
Occasionally a client with dry, normal, or combination skin will have clogged pores
on a few patterned areas – for example, on the cheekbones, from a comedogenic blush
product, or on the side of the face where the telephone is held. These comedones
are difficult to extract until the client has been on home care for several weeks.
DermaQuest™ Skin Therapy suggests that the professional makes minimally-aggressive
attempts to extract the comedones after a Firming Enzyme and Hydrating Gel Mask
Facial (See Balancing Facial, Appendix), then explain to the client that the skin
will need to be in better condition before they can be extracted. Send the client
home with at least the Daily Enzyme Cleanser and the Advanced B5 Serum, and possibly
the entire Balancing Kit, and make an extraction facial appointment for the client
to extract the comedones according to the skin condition.
Occasionally a client with dry or normal type skin will have closed comedones all
over the face (if the client has oily skin, the response will be a Grade 2 or 3
Acne condition). This client’s skin is likely being clogged by improper skincare
or makeup. The professional and home-care regimen should consist of a short Glycolic
or Lactic Acid Resurfacing Series. It is mostly a matter of opening the skin with
2-4 Resurfacing Treatments and getting him or her on correct home care (A Pre-Conditioning
Program and then monthly facials).
Grade 1 “occasional Breakouts”
Usually only inflammatory acne breakouts; will have few comedones on oily skin
This client will not always have breakouts, but they will appear when they are least
needed, such as just before a big (and stressful) event or possibly prior to menses.
The breakouts will be mostly papules or pustules, which will be especially sore,
and the skin will need constant preventive treatments to control the breakouts as
much as possible and to keep those that occur from being troublesome. One major
trigger is hormonal surges from stress.
Grade 1 acne affects all skin types - dry, normal, and oily. Most breakouts will
occur in the perioral hormonal area, but they can occur anywhere. A few comedones
may appear on oily skin. Home care will be appropriate to the skin type, plus preventive
products such as PM or alternate PM Beta Hydroxy Cleanser or Rejuvaderm. Purity
Spot Treatment is also appropriate on inflamed areas. Note that salicylic acid is
an anti-inflammatory and is an important treatment with this type of breakout. It
also calms the sebaceous glands, which are triggered by hormones.
Athletes have these types of breakouts during their playing season due to increased
hormones during competitive play. Breakouts may affect the face, areas where hats
or helmets come into contact with the skin, or the shoulders and chest. They may
go into a higher inflammatory grade if the area is not treated regularly and preventively.
Grade 2
“always broken out somewhere”
(mostly inflammatory acne breakouts; will have comedones if oily)
This type of acne can be very frustrating, and those who suffer from it will typically
have tried many regimens and over-the-counter products. Breakouts are mostly papules
and pustules, some comedones on oily skin, and, rarely, a cyst. If hormonally induced,
this acne is very dif- ficult to control, but it can be controlled with prevention
and proper products, taking it back down to Grade 1. The Acne Mask is important
in the home care regimen of this client.
Grade 3
“Broken out everywhere constantly”
(papules, pustules, some cysts, comedones)
This client is likely very unhappy with his or her appearance, with negative impacts
on personality and social interactions. This acne needs aggressive treatment, such
as a Salicylic Acid Resurfacing Series, to reduce it to Grade 2 as quickly as possible.
The key to success with Grade 3 acne cases is commitment to both the home care regimen,
including the DermaQuest™ Skin Therapy Acne Mask and other targeted products, as
well as professional care, including appropriate Extraction Facials and Salicylic
Acid Resurfacing Series treatments. Hydrating products are important for home care
and during treatments, as treatment-induced dehydration can cause significant renewed
acne activity.
Grade 4
nodulocystic acne – You should visit a Dermatologist for treatment
This client has a deep, overwhelming infection, involving cysts and nodules deep
within the skin and pustules and comedones in the upper follicles. This Grade of
Acne can be treated only at the physician level. The esthetic professional is important
to the treatment of acne in the physician setting or as a treatment partner, as
this professional can monitor the client’s progress and calm the skin, while motivating
the client to maintain important home care regimens. Dermatologists are realizing
also that esthetic level treatment and care, such as Salicylic Acid Resurfacing,
is a ‘try-first’ opportunity before moving to antibiotics. Frequent, persistent
treatments and committed home care can dramatically improve a client’s skin; even
control some cases of severe acne, without resorting to antibiotics and Accutane.
Due to the development in recent years of antibiotic-resistant bacteria, many dermatologists
are now holding antibiotic treatment to only the most severe cases, trying other
treatments first, including esthetic care. In the most highly resistant, severe
acne that does not respond to esthetic care, the next step of treatment is a round
of antibiotics accompanied by topical products as well as Extraction Facials to
calm the skin and hopefully correct the infection. If this does not clear the skin,
Accutane, a medication with many side effects, is prescribed.
Sixty percent of Accutane clients are cleared with one treatment round, but 39% have
recurring acne and must be treated with multiple rounds of the medication. It is
only used as a last resort due to its side effects, but it is a highly effective
drug.