Determine the type, severity, and location of acne, and presence of scarring.
Scars (Keloidal scarring is present on the central chest. The other three images show atrophic scarring on the face.)
Types of acne
Comedonal acne: Open (blackheads) and closed (whiteheads) 1-2 mm follicular-based papules. Some of the lesions are excoriated.
Inflammatory acne: The lesions of inflammatory acne include erythematous papules and pustules, nodules and cysts. These are often seen in conjunction with comedones.
Nodular acne: Nodules are present on the upper right forehead and bilateral medial cheeks, in addition to inflammatory papules, pustules, and scars.
Neonatal acne: Inflammatory papules and milia on the cheeks of an infant (left) and inflammatory papules and pustules (middle) and crusted papules (right).
Acne with scarring: Atrophic acne scars in the setting of inflammatory papules and pustules (left) and keloid formation (right).
Severity of acne
- Mild-to-moderate: mostly facial, usually non-scarring, mostly comedones, papules, and pustules
- Moderate-to-severe: numerous lesions, can also involve the trunk, may scar, comedones, papules, pustules, nodules or cysts present
- Severe: presence of scarring in the setting of comedones, papules, pustules, nodules or cysts, involvement of trunk is common
See the chapter Acne Vulgaris in A Clinical Atlas of 101 Common Skin Diseases.
- Presence of hormonal imbalances (polycystic ovary syndrome, oral contraceptives, exogenous androgens) or clear history of exacerbation related to menses
- Systemic medications (anabolic or corticosteroids, OCPs, psychiatric medications, chemotherapy)
- Occlusive topical agents
- Mechanical irritation
- Self-manipulation of lesions (picking)
- The role of diet, sun exposure, and smoking are controversial
Pityrosporum or other infectious folliculitis