Grade 1: Mild Acne

  • Clinical findings: Dominated by open and closed comedones (blackheads and whiteheads).
  • Inflammation: Minimal, often confined to the face.
  • Lesions: May include a few papules (small, red bumps) or pustules (pus-filled bumps).
  • Scarring: Rarely causes scarring. 

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Grade 2: Moderate Acne

  • Clinical findings: Increased number of comedones, accompanied by mild papules and pustules.
  • Inflammation: Visible inflammation, typically on the face.
  • Lesions: Larger, more apparent pustules with some inflammation.
  • Distribution: May spread to the neck, chest, and back.
  • Scarring: Risk of minor scarring if not properly treated. 

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Grade 3: Moderately Severe Acne

  • Clinical findings: Numerous papules and pustules.
  • Inflammation: Significant inflammation, often accompanied by pain.
  • Lesions: Occasional inflamed nodules (hard, painful lumps deep under the skin).
  • Distribution: May involve the face, chest, and back.
  • Scarring: Higher risk of scarring due to deeper inflammation. 

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Grade 4: Severe Nodulocystic Acne

  • Clinical findings: Characterized by a large number of painful, inflamed nodules and cysts.
  • Inflammation: Extreme inflammation, often causing significant pain and swelling.
  • Lesions: Numerous large, deeply embedded nodules and cysts.
  • Distribution: Widespread, covering the face, chest, back, and shoulders.
  • Scarring: High risk of significant scarring. 

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