The Difference Between Mild, Moderate, and Severe Acne

Skin Symptoms & Concerns

The Difference Between Mild, Moderate, and Severe Acne


Photo by Amanda Dalbjörn on Unsplash

Most of us (okay, probably all of us) would much rather have smooth, flawless skin than have to deal with any sort of acne.

But, if you’re going to have the occasional breakout, you’d much rather have a couple of small whiteheads than deep, painful, and angry red pimples, wouldn’t you? Yep.

Sigh. However, anyone with acne will tell you that you typically don’t get a say in how brutal your own breakouts are. Acne is categorized based on its severity and there’s a pretty noticeable difference between mild acne and severe acne—both in terms of appearance and even the level of discomfort it causes.

How can you know which type of acne you’re dealing with? And how does that play a role in finding the right treatment options? We have the answers you need right here.

What are the different severities of acne?

As the Cleveland Clinic explains, dermatologists will rank acne into different grades depending on how severe it is. Generally, this categorization comes down to two different factors:

  • The type of pimples
  • The amount of pimples

Let’s start by talking about the different types of acne bumps you could be dealing with, starting from the mildest to the most severe:


Whiteheads and blackheads: These are very small white or black dots, also known as comedones. For that reason, you might hear the term “comedonal acne” to describe someone who has mostly whiteheads and blackheads, rather than larger breakouts.


  • Papules or pustules: These are larger and more inflamed pimples. Papules are raised red bumps, while pustules are pimples filled with yellow pus.
  • Nodules and cysts: Nodules are large, painful, red, and tender bumps on the skin. They don’t contain any fluid. Cysts are deep, pus-filled bumps.

Okay, so with that groundwork in place, let’s talk about each of the different severities of acne.

Grade 1: Mild acne

Type: Non-inflammatory acne (a.k.a. comedonal acne)

If you have mild acne, you’ll see mostly whiteheads or blackheads on your skin, rather than larger and deeper breakouts. You might see a few papules and pustules every now and then, but for the most part, you’re dealing with the smaller dots and clogged pores.

Grade 2: Moderate acne

Type: Inflammatory acne

With moderate acne, you’ll see several red papules and pustules that appear mostly on your face—usually in concentrated areas.

Grade 3: Moderate-severe acne

Type: Inflammatory acne

Not only do you have numerous papules and pustules (even more than someone with only moderate acne), you’ll also see the occasional inflamed nodule on your skin. As if that’s not frustrating enough, you might not just see bumps and pimples on your face. You could also have acne on your body—primarily on your chest and back.

Grade 4: Severe acne

Type: Inflammatory acne

By far the most painful, people with severe acne will have many large, inflamed, and painful pustules, nodules, and cysts on their face and their body.

How does the recommended treatment change depending on the severity?

After reading through that, it’s obvious that not all acne is the same. But, why does understanding the severity of your own acne matter?

Here’s the short answer: Because it’ll impact your treatment options. Obviously, someone who has acne that’s far more severe, painful, and disruptive will require more intense treatment than someone who has just a few whiteheads or blackheads.

If you’re curious about what types of acne treatments are typically used for each severity, here’s a quick breakdown of some common treatment options.

Treatment for mild acne

The first-line defense against mild acne typically starts with topical medications (lotions, ointments, and creams) that are applied directly to the affected areas. The most common ones for mild acne include:

These treatments aren’t just for mild acne though.

Treatment for moderate or moderate-severe acne

All of the above topical solutions that are used for mild acne can also be used for moderate or moderate-severe acne. However, dermatologists will typically recommend that those medications be combined with another treatment option, such as:

  • Antibacterial topical gel: An antibacterial topical gel like erythromycin or clindamycin targets inflammatory acne.
  • Oral antibiotics: Medication that helps to reduce bacteria and control acne. One of the most common is doxycycline.
  • Oral contraceptives: Some oral contraceptives help people who deal with breakouts from the hormone changes associated with their menstrual cycles.

But if your acne is more severe, here’s what you should think about.

Treatment for severe acne

Again, people with severe acne will likely use some of the above treatment options—whether they’re topical solutions or oral medications. But, they might also benefit from some other more intense and targeted treatments, such as oral retinoids like isotretinoin or steroid injections. Nodules and cysts can be directly injected with steroids to reduce pain and improve their appearance.

Severe acne is also far more likely to cause acne scarring and dark spots, so some dermatologists will recommend chemical peels or laser therapy to treat and manage those.

Finding the right treatment? It starts with severity

While any type of acne is frustrating to deal with, not every case of acne is created equal. It can run the gamut from a few small whiteheads to deep and painful pimples.

We know—reading about pus-filled bumps and cysts isn’t exactly anyone’s idea of a good time (especially if you’re unlucky enough to have to deal with them yourself). But, understanding the severity of your own acne is important for finding your most effective next steps.

The good news? Regardless of how severe your acne is, you can almost always find a treatment plan that will work well for you.

Article Reviewed By

Dr. Peter Young, MD, Facet Medical Director and Board-Certified Dermatologist

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