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Health Protocols


Diagnosis of Acne

Acne can be classified based upon the type and number of lesions present. The American Academy of Dermatology has formulated a scheme for the classification of acne; it has three basic levels (Vejjabhinanta 2011):

  • Mild acne is characterized by the observation of comedones and few papules and pustules (generally less than 10) and no nodules or cysts.
  • Moderate acne includes 10 to approximately 40 papules and/or pustules, with about as many comedones.
    • The appearance of less than 40 papules and/or pustules along with as many as 5 large or deep nodules denotes moderate to moderately-severe acne.
  • Severe acne is classified as more numerous papules and/or pustules with many nodules and/or cysts.

Acne can usually be diagnosed with a good degree of certainty based upon its outward appearance of characteristic lesions on the face, back, upper arms, and chest (Archer 2012). A health-related quality of life (HRQL) index is also applied in some cases to assess the psychological effects (and possible psychiatric conditions) in patients suffering from acne (Barnes 2012).

Underlying conditions that could cause acne should be ruled out. For example, polycystic ovary syndrome (PCOS), a condition in which women develop ovarian cysts and produce excessive testosterone, is associated with acne (Sam 2007; Kamangar 2012; Rehme 2013). Adrenal hyperplasia can also cause excess androgen production and is sometimes linked with acne (Degitz 2003; Reisch 2013).

Blood tests for dehydroepiandrosterone sulphate (DHEA-S) and testosterone are also sometimes useful in identifying androgen excess as the cause of an acne breakout (First Consult 2013).​