What is acne? Acne or acne vulgaris is a skin problem that occurs when oil and dead skin cells clog up your pores. Acne is most commonly known or characterized by blackheads, blemishes, whiteheads, pimples, or zits and can be categorized into mild or severe acne.


Mild forms of acne are classified by an appearance of several red spots or pimples. Severe acne occurs when the face, neck, chest, and back are significantly covered by hundreds of pimples, or even appear on the skin as cysts, manifesting in big, solid, painful red lumps.


Acne is very common among teens during their adolescent years although it is common to outgrow skin problems associated with acne post puberty. In some cases however, women who may not have experienced acne in their teen years may still experience acne as an adult, when breakouts occur most commonly before a menstrual period.


Knowing how to tackle acne is beneficial to your overall wellness and may impact you physically, psychologically as well as emotionally.  How you feel about your acne may not be related to its resulting appearance ie. How mild or severe it is. Studies have shown that while some people with severe acne are not bothered by it, others may suffer from embarrassment or experience negative emotions despite the appearance of just a few pimples. The good news is that managing acne as well as the emotions related to it has never been more successful. There are many high quality and excellent treatments available that can help you get your acne under control.


What causes acne? Acne is caused as a result of oil and dead skin cells that accumulate and clog the skin’s pores. When germs enter the pores, it results in swelling, redness, and pus. This forms what we know as acne. See a picture of how pimples form.


For the majority of people, acne begins during the teen years. This is due to hormonal changes that increase oil production in the skin once a young adolescent comes into puberty.


Acne is also known to be genetic. If one of your parents has had severe acne, you are more likely to experience similar skin problems.


In addition, using oil-based skin products or cosmetics only make acne worse. To manage an onset of acne, be sure to use skin products that will not clog your pores such as products with “non-comedogenic” on the label.



Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions and can be painful if they become infected. They can also lead to scarring of the skin.



Acne vulgaris (or cystic acne) is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), Nodules (large papules) and possibly scarring. It mostly affects skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms. The lesions are caused by changes in pilosebaceous units (structure consisting of hair, hair follicle, arrector pili muscle, and sebaceous gland) and changes that require androgen stimulation



Knowing the grade of your acne is an important step in treating acne. All acne grades require different treatment methods. Understanding the grade of your acne can help you choose the most effective course of treatment and assist you in selecting the right products to treat your acne. It will also help you decide if your acne is suited to being treated at home, or if more severe, whether you should see your dermatologist.


Grade I

Grade I acne is the mildest form of acne. These are minor pimples that are usually small in appearance, surface only very occasionally, and found in small numbers (one or two). Blackheads and milia will also be present, sometimes in great numbers, but there is no inflammation as a result of Grade I acne.


Grade I acne is commonly seen in early adolescence, especially in the nose and/or forehead. However, many adults also experience grade I acne as blackheads on the nose and forehead. Milia is commonly found around the eye area and chin in this stage of acne.


This type of acne can be successfully treated at home using an over-the-counter product containing salicylic acid. Results are generally seen very quickly. Treating acne while it is still in its early stages helps prevent acne from progressing, especially in teens. Grade I acne may progress to Grade II if left untreated.


Grade II

Grade II acne is considered moderate acne. Blackheads and milia are present at this stage, generally in greater numbers. You will start seeing more papules and the formation of pustules in this stage as well. They will appear with greater frequency, and general breakout activity will become more obvious. Slight inflammation of the skin is now apparent.


In teens, you may notice the acne progress from the nose and forehead to other areas of the face. Acne may start to affect the chest and shoulders, with occasional breakouts on the back, especially in men. Adult women may find greater breakout activity in the cheeks, chin, and jaw line area, especially just before and during their menstrual cycle.


Like Grade I acne, Grade II acne can still be treated at home, using over-the-counter products. In addition to a salicylic acid, a benzoyl peroxide lotion should be used daily to kill the bacteria that causes inflamed breakouts. However, if your acne does not significantly improve after several weeks of home treatment, it is time to see a dermatologist. Grade II acne may progress to Grade III acne, especially if pimples are habitually picked at or squeezed.


Grade III
This type of acne is considered a severe form of acne. The main difference between Grade II acne and Grade III acne is the amount of inflammation present. The skin is now visibly reddened and inflamed. Papules and pustules have developed in greater numbers and nodules are present.


Grade III acne is usually found in other areas of the body, such as the neck, chest, shoulders, and/or upper back, as well as the face. The chances of scarring are increased as the infection spreads and becomes deeper.


Oral medication should be taken to treat acne at this stage. Grade III acne is usually treated with both topical and systemic therapies available only by prescription. Left untreated, Grade III acne may progress to Grade IV acne.


Grade IV
As the most serious form of acne, Grade IV acne is often referred to as nodulocystic or cystic acne. The skin will display numerous papules, pustules, and nodules, in addition to cysts. There is a pronounced amount of inflammation and the breakouts are severe. Cystic acne is very painful.


Acne of this severity usually extends beyond the face, and may affect the entire back, chest, shoulders and upper arms. The infection is deep and widespread. Nearly all cystic acne sufferers develop scarring.


Grade IV acne must be treated by a dermatologist. It tends to be hard to control, and almost always requires powerful systemic medications in addition to topical treatments.


Acne can be treated in the following ways depending on how mild or severe it is.


Home treatments

To help control acne, keeping your skin clean is of vital importance. When buying skin care products, avoiding products that will clog your pores is the first step. Look for products that say “noncomedogenic” on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. These can make them worse and scarring may occur as a result.


If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. This works best when used according to the application instructions on the packaging.


Treating acne takes time and it can take as long or as short a time to get acne under control. However, if you find that your acne condition has still not improved by using nonprescription products after 3 months, it’s time to visit your doctor! A prescription gel or skin cream may be all you need!


In the most severe cases of acne, oral medications such as erythromycin, tetracycline, or doxycycline are recommended on a long term basis.  These medications reduce the production of oil and inflammation. However, it is useful to note side effects caused by these medications such as symptoms of nausea and occasional allergic reactions in some patients.


Dermatologist treatments

A stronger medication, which most dermatologists would recommend for severe acne, is ROACCUTANE capsules.


Accutane (also known as Isotretinoin), or Roaccutane as also known in some parts of the world, was discovered in 1979 when it was first administered to patients with severe acne conditions.  Most of these patients reacted positively with their acne symptoms clearing dramatically and permanently. Accutane or Roaccutane is a vitamin A derivative, which is administered orally in pill form, normally for a period of 15-20 weeks. Accutane was originally prescribed to people with severe acne conditions who did not respond to other treatments, but it has since gained popularity in the last 25 years and is now also being prescribed more and more frequently to people with less severe acne problems. This practice is controversial because Accutane is a serious medication and causes side effects, which can be devastating as they are widespread. Accutane need not be paired with other medications.


How Accutane works exactly on a cellular level is unknown but we do know that it affects all of the four ways that acne develops. It dramatically reduces the size of the skin’s oil glands (35%-58%) and even more dramatically reduces the amount of oil these glands produce (around 80%).


Acne bacteria (P. acnes) live in skin oil. Since oil is so dramatically reduced, so is the amount of acne bacteria in the skin. Not only does it slow down the rate at which the skin produces skin cells inside the pores, which in turn prevents pores from becoming clogged in the first place, it has been shown to contain anti-inflammatory properties.


Although it has been found that acne may worsen within the first month of Accutane use in approximately 30% of patients, the ultimate result is usually dramatic. Accutane works to achieve partial or complete clearance of acne in about 95% of people who complete a cycle, regardless of whether they have inflammatory or non-inflammatory acne. The majority of people who take it see their acne effectively cured, experiencing long-term remission of acne symptoms. Studies show an average relapse rate of approximately 33%, and in these cases, a second course is sometimes given. This relapse rate is dose-dependent as patients who receive a cumulative dose of 100-120 mg/kg see the best results and experience the lowest relapse rates. Patients who receive a lower dose relapse more frequently.


Accutane Dosage for severe acne treatment: Daily dosage depends on how much the patient weighs; 0.5 mg – 2 mg/kg is typical.14


Low and intermittent dosing: Researchers have published two studies attempting to gauge whether people with mild to moderate acne can achieve long term remission of acne with lower dosages of Accutane. Initial data shows that people with mild to moderate acne may be able to achieve long term remission with only about 75% of the usual Accutane dose, and thus suffer fewer side effects. Intermittent dosing (taking Accutane only 1 week every month) appears to work less well, producing inadequate results for more than half of the patients studied.


Accutane side effects

As used in the treatment of severe acne, the side effects caused by Accutane are numerous and widespread, and affect more than 80% of patients who use it.  Side effects are most often mild to moderate and reversible, but in rare cases can be severe or long-term. The side effects are:
Hair loss, Alopecia, Pressure within the skull, headaches, neurological symptoms, depression, vision problems, reduced blood flow to the brain, nosebleed, excess hair in women, hearing impairment, yellowish deposits in eyelids, severe allergy, inflammation of the lips, dry skin, dry lips, dry mouth, bleeding and inflammation of the gums, rash eczema, hives, increased sunburn susceptibility, nail abnormalities, oozing bleeding skin bumps, rapid breakdown of muscle tissue, overgrowth of bone, bone calcification, ligament calcification, tendon calcification, abnormal blood tests, low blood platelets count, blood disease, low iron content in blood, arthritis, respiratory symptoms, low white blood cell count, joint pain, acute lasting arthritis, muscle pain, tendonitis, elevated liver enzymes, low back pain, inflamed pancreas, inflammatory bowels and abdominal ulcers.



Chromolite™ acne clearance


How do we treat acne effectively and successfully, devoid of any side effects? At Face of Man, we utilize the latest Intense Pulse Light (IPL) treatment for moderate (grade 1) to severe acne (grade IV) conditions. This is conducted using the renowned technology of the Smartlite™.  During your treatment, a greenish yellow light is emitted which ionizes the clogged acne pore, thus building up an oxygenated environment that destroys the acne causing bacteria (propionibacterium). It also emits a red light to warm the skin, which reduces inflammation. Clinical studies show that acne can be treated in four weeks with eight sessions of IPL treatment with zero side effects unlike oral medications.

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