In my 15 years working in the field of esthetics I have to say that the most common skin concern I dealt with was acne vulgaris. In fact, beginning from the time I was a pre-teen, I suffered from acne, and I continue to struggle with what is called adult onset acne. If you are one of the 50 million Americans a year who suffer from acne vulgaris, this article is for you. In this article I will start to demystify this very frustrating skin condition. The acne vulgaris that I have seen on my clients over the years, and even my own case of acne vulgaris, tended to shift and change. Increased stress and fluctuation in hormones are commonly the cause. Some clients come in with one pimple on their chin and say they have acne. Others come in with blackheads, whiteheads, and cysts all over their face, chest, and back. Between these two cases, who would you classify as having true acne?
The answer is both. Acne afflicts people in a wide range of severity. Skin care professionals who know their stuff, know that there are 4 grades of acne. We can classify which grade you have by the form and severity presented to us at the time of treatment. Correctly identifying which form of acne you have is important because it allows your skin care professional to choose the most appropriate form of treatment.
The Four Grades of Acne Vulgaris
Grade 1 – Mild Acne Vulgaris
Characteristics: Micro-comedones, closed comedones, and open comedones. No redness or inflammation.
This grade of acne vulgaris is mild and very easy to treat. Generally, the open comedones (aka blackheads) are found in the “t-zone”- the forehead, nose, and chin. Blackheads develop when excess sebum (oil) collects inside the follicle and clogs it. The blackhead gets its color, not from dirt, but from the oxidation of sebum that is exposed to air, similar to when an apple turns brown after you cut it.
How CBD can help: CBD can be taken internally as well as used topically. When used topically, it can slow down the production of sebum, which leads to less oily skin and less acne. Treating grade 1 acne vulgaris can be done in an estheticians treatment room. The use of steam during a facial will soften the sebum so the esthetician can extract them easily. Home care will consist of cleansing the skin with either a salicylic acid wash, a glycolic acid treatment, or a benzoyl peroxide wash. Important also is exfoliating regularly and hydrating the skin with an oil free moisturizer.
Grade 2 – Mild Acne Vulgaris / Inflammatory Papules
Characteristics: Micro-comedones, closed comedones, open comedones and some inflammatory papules. Redness may be present around the papules.
With grade 2 acne vulgaris, you will see a greater number of open comedones (blackheads), closed comedones, papules (a small, raised, solid pimple or swelling – no pus) and whiteheads. These will be random over the face, rather than in the T-zone.
Treating grade 2 acne vulgaris can also be done in an estheticians treatment room. Exfoliation, steam and anti-bacterial products will likely be used. Extractions will be done, however, each state dictates whether a lancet can be used in extractions. Topical treatment at home will be a must if you don’t want this to progress into grade 3 acne vulgaris. Your skin care therapist or dermatologist will be able to expertly guide you to the right home care system. Expect recommendations such as a stronger glycolic acid wash to aid in more rapid exfoliation. SPF is an important habit to get into for everyone but most especially for people who are undergoing exfoliating acne treatments.
How CBD can help: Again, CBD can be taken internally as well as used topically. When used topically, it can slow down the production of sebum, which leads to less oily skin and less acne. CBD also has anti inflammatory properties, and acne vulgaris is an inflammatory disease.
Grade 3 – Acne Vulgaris
Characteristics: Comedones, papules, and pustules
Grade 3 acne vulgaris presents with a higher amount of blemishes over the skin, and the inflammation is more pronounced. Blemishes may be so dense, they begin to merge together beneath the surface of the skin, causing multiple follicles to become infected, instead of a single follicle. The skins underlying structure is compromised, increasing the likelihood of acne scars.While treatment of this grade of acne can be done by an esthetician, I believe that working in conjunction with a dermatologist will bring the best results. Grade 3 acne vulgaris is a skin infection, requiring medical treatment. An esthetician can provide deep cleansing and aid in soothing and calming inflammation. Deep exfoliants should be avoided as this can increase the possibility of the infection spreading. Light extractions would be up to the discretion of your esthetician, but they should focus on open comedones. It may be tempting for you to “pop” the pimples, but do NOT do this. The risk of spreading the infection and of scarring is just not worth it. Popping pimples can also force the infection deeper into the skin, which will aggravate the skin even more.
How CBD can help: Yes, you guessed it: CBD can be taken internally as well as used topically. When used topically, it can slow down the production of sebum, leading to a reduction of oils on the skin, on of the triggers of acne. CBD also has anti inflammatory properties, and acne vulgaris is an inflammatory disease. Stress and anxiety can trigger acne, however, CBD is known to calm anxiety, thus removing this trigger.
Grade 4 – Cystic Acne Vulgaris
Characteristics: Comedones, papules, pustules, nodules, and cysts.
Grade 4 acne vulgaris is the most severe form of acne. Blemishes are very large, inflamed and can cover most of the face, neck and upper body. Deep blemishes, knows as cysts are large, smooth, and painful to the touch. Nodules are hard lumps with no pus or fluid. Due to the size and severity of the blemishes, scarring is a very real possibility. This form of acne is beyond the scope of an esthetician and should be treated by a dermatologist. Your dermatologist will likely put you on a course of topical and/or oral antibiotics, and you may speak to them regarding more aggressive forms of pharmaceutical drugs to treat this very difficult form of acne vulgaris. A good dermatologist will speak to you in depth regarding your options, and explain to you the pros and cons of such a treatment course. If you are not satisfied with the treatment that is recommended by your dermatologist, it would be wise to get a second opinion.
How CBD can help: As mentioned before, CBD helps normalize sebum production, as well as aids in reducing stress and anxiety, two triggers causing acne vulgaris. At this advanced stage in acne vulgaris however, no matter what alternative treatments you may be using, it is still recommended that a dermatologist is involved in your care. You should speak to your treating physician about using CBD, as they should be informed of all agents used on the skin as they treat you.
No matter what grade of acne vulgaris you may be suffering from, it is a physically and emotionally painful thing to endure. Your quality of life can suffer, but you don’t have to go it alone. Reach out to me and I will help you know which grade of acne you have, as well as how to best care for your skin at home. I will also help you know if it’s something you can treat at home, in an esthetician’s treatment room, or if you need to see a dermatologist.
Questions? Leave them in the comments below, or post them on any of my social media outlets. Share this article with someone who you know i suffering from acne vulgaris.