DR1.1 | Acne Recognition and Grading — Summary & Reflection

KEY TAKEAWAYS

Acne vulgaris is a clinical diagnosis made by recognising its lesions and grading their severity. Lesions divide into non-inflammatory comedones — open (blackheads) and closed (whiteheads), the primary defining lesions — and inflammatory lesions in increasing depth: papules, pustules, nodules, and cysts, with nodules and cysts carrying the highest scarring risk. Four interacting pillars drive the disease: androgen-driven excess sebum, follicular hyperkeratinisation, Cutibacterium acnes proliferation, and inflammation, and each is a treatment target. Key risk factors include adolescence, family history, hyperandrogenic states (PCOS), comedogenic cosmetics, and certain drugs; sudden severe acne with virilising features in a woman warrants a hormonal workup (testosterone, DHEAS, LH:FSH ratio). Severity is graded with the IGA (0–4) or GAGS (mild 1–18, moderate 19–30, severe ≥31), with nodules, cysts, or scarring pushing a patient to severe regardless of count. The comedone is the single most useful discriminator from mimics (rosacea, perioral dermatitis, drug-induced acneiform eruptions). Above all, the grade you assign directly determines management: topical for mild, oral added for moderate, and isotretinoin considered for severe — the bridge into the management SDL.

REFLECT

Think back to someone you have known — a classmate, a relative, or a patient seen during your postings — who lived with acne. Beyond the spots themselves, what was the impact on how they felt about themselves, how they behaved socially, or how confidently they engaged with others? Now reflect honestly on how you would have assessed their skin a month ago versus now: would you have been able to name each lesion type and assign a severity grade, and would that grade have changed what you advised? Consider how the simple discipline of looking carefully, naming lesions, and grading severity transforms a vague complaint of 'pimples' into a precise, defensible clinical decision — and how communicating that grade and a clear plan to an anxious young patient is itself a therapeutic act that addresses the distress, not only the skin.