Painful Acne Under the Skin
In most people, acne is more annoyance than serious condition. But in a small percentage of teenagers and adults, the condition can worsen until infection sets in beneath the skin, causing pain, along with pockets of pus and inflammation. If you have painful acne under your skin, you'll need help from a dermatologist.
Severe acne starts like all other cases of acne, when excess oil in your skin begins to clog your pores. In milder forms of acne, these blockages form whiteheads, blackheads and smaller pimples, according to the Cleveland Clinic. But in severe acne, bacteria grow out of control, causing serious infection. Severe acne can involve cysts and nodules below the skin's surface, pain and significant swelling, according to the Academy of Dermatology.
The Academy of Dermatology recognizes four distinct types of severe acne: acne conglobata, acne fulminans, nodulocystic acne and gram negative folliculitis. All involve pain, infection and inflammation. Acne conglobata can cause deep, burrowing abscesses, while acne fulminans involves inflammation that can spread throughout the body. Nodulocystic acne involves painful bumps beneath the skin, and gram negative folliculitis appears when your hair follicles become infected with a bacteria that's resistant to antibiotics
Your dermatologist will determine your treatment, based on the type of severe acne you have. But in many cases, the overall treatment plan will include a combination of medications and procedures. If you have large, painful cysts, your dermatologist may elect to remove them surgically by draining and extracting them. You might receive injections of a corticosteroid solution into your worst cysts, which can help dissolve them and prevent them from causing scars.
Many dermatologists prescribe oral antibiotics to treat the infection under the skin, according to the Academy of Dermatology. Erythromycin can treat acne, and dermatologists also prescribe tetracycline and its derivatives doxycycline and minocycline for bad acne. If you're a woman, you might also try oral contraceptives, which can tame the hormonal fluctuations that trigger acne.
If your severe acne includes pockets of painful infection under the skin, your dermatologist may recommend that you take the prescription medication isotretinoin, which is marketed under the brand name Accutane. The Academy of Dermatology calls isotretinoin "the most effective acne treatment available." But it also can cause very serious side effects, including severe birth defects. Because of this, women taking isotretinoin must use two forms of birth control. The medication also has been linked to serious depression and severe pain in the chest and abdomen.
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