Acne Grading Scale: Knowing Your Acne Type

Acne Severity Scale

Acne Grading

There are more than 25 acne grading systems used in the world today. However, there is no common consensus on which one to use. Acne grading depends on the type of the lesion (papules, pustules, comedomes, nodules and/or cyst), the number of lesions and the surface area involved. Even so, the different grading system can be tedious and subjective as they may involve counting individual acne lesions or comparison using photographs.

Why Do We Need To Grade Acne?

Acne grading is the first step to guide proper and successful treatment. Individuals with mild acne will largely benefit from topical acne therapy, whereas those with more severe grades of acne will benefit from oral therapy.

Furthermore, it has been shown that patient’s perception of their acne severity may differ from clinical assessment. If you perceive your acne to be mild when you are in fact suffering from severe acne, you may delay treatment and risk acne scarring.

What Are The Common Acne Grading Systems?

The most commonly Acne grading tools used today are:

  • Investigatory’s global assessment (IGA) 
  • Global Acne Severity Scale (GEA)
  • Comprehensive Acne Severity Scale (CASS)

The grading systems takes into account the type of acne lesions:

  • Non-inflammatory leisons (whitehead and blackheads)
  • Inflammatory lesions (papules and pustules)
  • Nodulo-cystic leions

Taking into account the type and quantity of the acne lesion, a grade is given, using a numeric scale. For example, 0-Clear to 5 Very-Severe. 

Global Acne Severity Scale (GEA)

Clear. Residual pigmentation and redness
Almost Clear
A few scattered open and closed comedomes. A few papules.
Less than half the face involved. A few open and closed comedomes. Also a few papules and pustules.
More than half the face is involved. Numerous open, closed comedomes, papules and pustules. One nodule may be present,
Inflammatory acne. Numerous open, closed comedomes, papules and pustules. Few nodules and cysts.
Very Severe
Highly inflammatory acne covering the affected areas. Many nodules and cysts present.

The Future of Acne Grading?

While no acne grading system is perfect (which is why there are more than 25 different ones), computational analysis based on imaging may reduce the subjectivity and improve uniformity to help guide treatment. Incorporating artificial intelligence in diagnosis will lead to more accurate diagnosis and more effective acne treatments.

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