How severe is my acne?
Grade six regions — forehead, each cheek, nose, chin, and chest & upper back — by the single worst lesion type present, and the Global Acne Grading System (GAGS) weighs them into a score from 0 to 44 with the severity bands dermatologists use. Save dated scores to track treatment response. Everything stays on this device.
None — No acne lesions in this region.
Comedones — blackheads / whiteheads. One or more comedones (open or closed); no inflammatory lesions.
Papules — small inflamed red bumps. One or more papules — small raised inflamed lesions without visible pus.
Pustules — pus-filled spots. One or more pustules — inflamed lesions with a visible purulent (white/yellow) centre.
Nodules — deep, firm lumps. One or more nodules — large, deep, frequently painful lesions.
Mild, mostly comedonal acne responds well to a consistent over-the-counter routine — build one matched to your skin with the Routine Finder. When the score sits in moderate territory or above, or nodules appear anywhere, the acne therapy guide walks through what dermatologists actually prescribe next, step by step, and when it’s time to escalate.
Source: Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol. 1997;36(6):416–418.
This is an educational self-assessment, not a diagnosis. GAGS is a clinician-oriented severity instrument and self-scoring is approximate — small grading differences between assessors are normal. Share the result with your GP or dermatologist rather than acting on it alone.
Saved only on this device — and browsers erase site data. A history clear, a private window, or Safari's automatic deletion after seven days without a visit will take this log with it. The fix is a free Dermington account: it backs this up automatically and puts it on every device you sign in to — details in how storage works.
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How the GAGS score works
The Global Acne Grading System (Doshi, Zaheer & Stiller, International Journal of Dermatology, 1997) turns a question as fuzzy as “how severe is my acne” into a number a dermatologist can act on. The face and trunk are divided into six regions — forehead, right cheek, left cheek, nose, chin, and chest & upper back — and each is graded 0–4 by the single most severe lesion type present: comedones (blackheads and whiteheads) score 1, papules (small inflamed red bumps) 2, pustules (pus-filled spots) 3, and nodules (deep, firm, often painful lumps) 4. Each grade is multiplied by a fixed region factor — ×2 for the forehead and each cheek, ×1 for the nose and chin, ×3 for the chest and upper back — and the six local scores are summed to a global score from 0 to 44.
The severity bands follow the convention proposed with the instrument: 1–18 is mild, 19–30 moderate, 31–38 severe, and 39 or above very severe. What the bands are for is deciding the next move: mild, comedone-dominated acne is over-the-counter territory — the Routine Finder can build that regimen — while moderate scores and anything above belong in the acne therapy guide, where prescription options come into play. Because acne treatment is judged over 8–12 week blocks, the real power is repetition: save a dated score, treat consistently, and re-score monthly. The trend answers “is this working?” better than any mirror. Everything runs and stays on this device — nothing is uploaded anywhere.
Common questions
How severe is my acne if it’s mostly blackheads and whiteheads?
In GAGS terms, comedones are grade 1 — the lowest lesion grade above clear skin — so even comedones across every region lands you in the mild band (1–18). That’s genuinely useful information: comedonal acne is the picture that responds best to a consistent over-the-counter retinoid like adapalene, and it rarely needs anything stronger if you give the routine a full 8–12 weeks to work.
When should I see a dermatologist for acne?
Three signals, any one of which is enough: a GAGS score of 19 or higher (the moderate band), nodules in any region regardless of the total, or any acne that’s leaving scars or dark marks behind. A fourth worth adding — a diligent over-the-counter routine that hasn’t moved the needle after two to three months. Prescription options exist for exactly those situations, and earlier treatment is the best scar prevention there is.
What’s the difference between papules, pustules, and nodules?
Depth and contents. Papules are small, raised, inflamed red bumps with no visible pus; pustules are inflamed lesions with a visible white or yellow centre; nodules are large, deep, firm lumps that are frequently painful and sit well below the surface. Grading a region means naming the worst type present — one nodule outranks a field of papules.
Why does the chest and back count three times as much as the nose?
Each GAGS region carries a fixed factor — the cheeks and forehead ×2, the nose and chin ×1, and the chest and upper back ×3 — reflecting how much skin each area represents in the original instrument. Multiplying the lesion grade by that factor means a nodule across the trunk (4 × 3 = 12 points) moves the global score far more than the same lesion on the chin (4 × 1 = 4), which mirrors how dermatologists actually weigh extent.
Where do my saved acne scores go?
Into your own browser’s local storage on this device — nothing is uploaded to Dermington or anywhere else. The trade-off is that clearing browser data erases the history and scores won’t follow you to another device, so if you’re building a treatment-response record worth keeping, download a backup from Your data. A dated trend is far more persuasive at an appointment than “it’s been bad lately.”