Many people can diagnose acne on their own, particularly in mild cases; most people recognize the symptoms of this very common skin condition. But while you may be familiar with what an occasional zit looks like, there is actually a wide range of severity. Seeing a dermatologist to formally diagnose acne can be very helpful, as different grades of acne usually require different types of treatments. There are also several other skin conditions that mimic acne, which may need a different approach entirely.
:max_bytes(150000):strip_icc()/GettyImages-548301399-5707efe83df78c7d9ea4f841.jpg "How Acne Is Diagnosed and Graded (1)")
Self-Checks
Acne isn't something you need to do a purposeful check for, like you do skin cancer. Rather, it often makes itself well-known when you simply look in the mirror or take a shower.
Symptoms may include blackheads (comedones), whiteheads (pustules), and sometimes inflamed nodules or cysts. All of these symptoms occur due to blockage of a pore.
Mild acne often doesn't require medical consultation and can be treated at home using over-the-counter products. However, if you are unsure if what you are experiencing is acne, or if your acne seems severe or is changing characteristics, see a dermatologist.
Labs and Tests
Acne is diagnosed by a simple visual inspection by your healthcare provider. There is no test for acne. Rarely, a practitioner may take a swab or scraping of a lesion or pustule for microbiological examination or culture to rule out other sources of infection.
For women, hormone blood tests may be ordered to look for conditions such as pregnancy, excessive prolactin, Cushing syndrome, and high testosterone (an indicator of polycystic ovaries).
Imaging
Imaging is not used in diagnosing acne. But if there are indications of predisposing conditions such as ovarian cysts, ovarian tumor, or adrenal tumor, the healthcare provider may order X-rays, CT scans, or MRI studies.
Differential Diagnoses
Some skin conditions can look remarkably similar to acne, although their causes and treatments are different. If you are unsure, it is always wise to consult a dermatologist. They will consider these options and systematically rule them out during your examination.
Rosacea
Rosacea is sometimes mistakenly referred to as "adult acne," but it is caused by a different mechanism than acne in adults. You may need to see a dermatologist to distinguish these conditions early on.
Rosacea causes red, flushed skin with papules and pustules, especially in the nose and cheek area, and may lead to the classic enlargement and bumpiness of the nose, for which it is best known. It is uncommon before the age of 30 and occurs more often in fair-skinned individuals and women (though it tends to be more severe in men).
Could Your Acne Really Be Rosacea?
Folliculitis
Folliculitis is a condition in which the hair follicle is inflamed and bumps or pustules may result. It is usually caused by bacteria (e.g., strep or staph) and is treated with topical or oral antibiotics.
Folliculitis, Furuncles, and Carbuncles
Keratosis Pilaris
Keratosis pilaris is a rash marked by small, rough, "goose-flesh" like bumps most often found on the upper arms, thighs, and buttocks, and sometimes the face. It commonly occurs at the same time in life when acne is prevalent, and roughly 50% of teens have some degree of the condition.
Miliaria Rubra
Miliaria rubra is a rash characterized by small red bumps on the surface of the skin and is caused by excessive heat exposure. It is also known as heat rash or prickly heat.
Heat Rash
Rashes Due to Certain Cancer Drugs
Some targeted therapy drugs for cancer, such as Tarceva (erlotinib), cause a rash that closely resembles acne. People who are taking these medications may frantically try using acne preparations but with no success, since the rash is due to a mechanism unrelated to that of acne.
If you have a rash that looks like acne while going through cancer treatment, talk to your oncologist.
Steroid Acne
Steroid acne, which is caused by taking oral steroids such as prednisone, can mimic true acne.
Skin Conditions That Cause Pimples
Acne Grades
When a dermatologist lands on a diagnosis of acne, it is classified into one of four grades. Dermatologists evaluate the types of comedones (blackheads) present, amount of inflammation present, breakout severity, how widespread the acne is, and what areas of the body are affected.
Through this, they will also decide what class of acne a case falls into:
- Non-inflamed acne breakouts have open and closed comedones (blackheads)
- Inflamed acne breakouts have papules, pustules, nodules, and/or cysts
| Acne Grade | Severity |
|---|---|
| I | Mild |
| II | Moderate |
| III | Moderate to severe |
| IV | Severe (cystic) |
Grades of acne are classified as follows:
- Grade I: The mildest form of acne is referred to as grade I. With grade I acne (mild acne), the skin will display blackheads, whiteheads or milia, and occasionally minor pimples. There is no inflammation (minimal redness, swelling, or tenderness). Grade I acne can usually be cleared with over-the-counter treatments.
- Grade II: Grade II acne is considered moderate acne. A greater number of blackheads and whiteheads are present on the skin than with grade I. Papules and pustules (whiteheads) are more frequently found. Grade II acne may also be treated with over-the-counter products. However, if there is no improvement after six to eight weeks, consult your healthcare provider.
- Grade III: Grade III acne is considered moderate to severe acne. The difference between Grade II and Grade III acne is the amount of inflammation present. Papules and pustules will be more numerous and there will be a greater amount of redness and inflammation found on the skin. Nodules are often present. This type of acne should be evaluated by your dermatologist, as it can be both painful and leave behind scars.
- Grade IV: Grade IV acne is the most severe grade of acne. With grade IV acne the skin will display many pustules, nodules, and cysts. Blackheads and whiteheads are usually numerous. There is pronounced inflammation, and breakouts likely extend to areas other than the face, such as the neck, upper chest, and back. Grade IV acne, also called cystic acne, must be treated by a dermatologist.
Acne breakouts that occur during your period (a.k.a. "period acne") tend to affect the chin, jawline, neck, chest, and upper back and often involve large, painful cystic acne.
A Word From Verywell
A proper diagnosis of acne includes not only a confirmation of the classic findings but a description of the severity of the rash. Determining the severity is important in choosing the best treatment options to improve your comfort and minimize scarring. If you are coping with acne that is grade II or higher, or even if you have mild acne that is not responding to over-the-counter medications, make sure to consult a dermatologist. Fortunately, treatment options are available for even the most severe types of acne.
Frequently Asked Questions
How is acne diagnosed?
A healthcare provider can diagnose acne by looking at your skin. They will also review your medical history and ask questions to see if there may be any reason for your acne. This may include asking about any medications you take, whether acne runs in your family, if there have been any changes in your skincare routine, or if you are experiencing menopause or any other condition.
What kind of healthcare provider diagnoses acne?
Most healthcare providers can diagnose acne, but a dermatologist (a doctor specially trained in conditions affecting the skin) is usually best suited to identify the type and stage of acne you have, how it can be treated, or if some other skin condition is involved.
Learn MoreWhat to Expect at Your First Dermatology Appointment
What tests can a healthcare provider use to diagnose acne?
Tests really aren’t needed to diagnose acne. If tests are ordered, they are mainly used to exclude other causes. This may involve taking a scraping of skin or a swab of pus to examine in the lab. Some breakouts may not be acne at all but other conditions like folliculitis, furuncles (boils), or keratosis pilaris.
See AlsoWhat can clear severe acne?How is hormonal acne diagnosed?
Acne in adult females may be caused by hormonal changes related to pregnancy, menopause, or conditions like Cushing syndrome or polycystic ovary syndrome (PCOS). Even hormonal fluctuations during your menstrual cycle can cause a breakout. Blood tests can reveal if you have any hormonal imbalances that might trigger a breakout. Based on these and other findings, additional tests may be ordered to pinpoint the cause or contributing factors.
Can acne be cured?
Isotretinoin is a cure for acne in 80% of people who complete a full course. Also, acne in adolescents, teens, and younger adults often improves as they get older. If acne is the result of an underlying medical condition, it may resolve once the condition is treated. If acne is related to medications, such as steroids, it may disappear once the treatment is changed or stopped.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Dermatology Association. Acne: Signs and Symptoms.
Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a Clinical Review.Dermatol Reports. 2016;8(1):6387. doi:10.4081/dr.2016.6387
KidsHealth. Staph Infections.
American Academy of Dermatology Association. Keratosis Pilaris: Diagnosis and Treatment.
Merck Manual Professional Version. Miliaria.
American Cancer Society. Targeted Therapy Side Effects.
Kraft J, Freiman A. Management of acne.CMAJ. 2011;183(7):E430–E435. doi:10.1503/cmaj.090374
Bagatin E, Freitas THP de, Rivitti-Machado MC, Ribeiro BM, Nunes S, Rocha MAD da. Adult female acne: a guide to clinical practice.An Bras Dermatol. 2019;94(1):62-75. doi:10.1590/abd1806-4841.20198203
Oge’ LK, Broussard A, Marshall MD. Acne vulgaris: diagnosis and treatment.Am Fam Physician. 2019;100(8):475-84.
Zeichner JA, Baldwin HE, Cook-Bolden FE, Eichenfield LF, Fallon-Friedlander S, Rodriguez DA. Emerging issues in adult female acne.J Clin Aesthet Dermatol. 2017;10(1):37-46.
By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.
See Our Editorial Process
Meet Our Medical Expert Board
Was this page helpful?
Thanks for your feedback!
What is your feedback?
