Acne Underneath the Skin
Many people think the skin condition acne involves pimples on the skin's surface. But in the most severe types of acne, abscesses can develop below the surface of the skin, potentially causing pain, infection and scarring. The types of acne underneath the skin almost always need attention from a dermatologist, according to the American Academy of Dermatology.
If your skin's sebaceous glands make too much oil, you'll tend to get acne, according to MayoClinic.com. The oil joins with cellular debris such as dead skin cells to form soft blockages in your hair follicles. If a blockage forms at the skin's surface, you'll wind up with a whitehead or a blackhead in that follicle. But when blockages form much lower in your hair follicles, you can develop a cyst. These cysts deep underneath the skin are prone to bacterial infection.
Severe acne generally occurs in four different types, according to the AAD. In nodulocystic acne, the most common type, your skin develops painful lumps well under the surface. Acne conglobata forms when inflammatory nodules form around clusters of pimples and then increase in size. This can lead to large abscesses that tend to burrow beneath the skin. Gram negative folliculitis involves hair follicle infections by certain strains of bacteria. And in acne fulminans, the fourth type of severe acne, ulcerating lesions couple with fever, inflammation and aching joints.
To treat severe acne underneath the skin, your dermatologist likely will prescribe one or more medications, according to the AAD. Prescription drugs frequently used in severe acne treatment include oral antibiotics, which can help you knock out the bacteria that's making the acne infection worse. In addition, the drug isotretinoin, which is marketed as Accutane, often successfully combats even the most severe acne cases. However, isotretinoin also has been linked with numerous side effects, some severe, so dermatologists tend to hold it in reserve for only the worst acne cases.
In some cases, dermatologists remove large cysts surgically in an effort to prevent depressed acne scars from forming, according to the AAD. If you have cysts that haven't responded to medication, your dermatologist may drain them and then extract them as part of an in-office surgical procedure. Dermatologists also can inject severely inflamed acne cysts with a mild solution that includes an inflammation-fighting corticosteroid drug, which promotes healing.
Acne underneath the skin can be difficult to treat, but the AAD stresses that treatment is critical to avoid scars from forming. However, patients also need to understand that not every case of acne responds to every medication or procedure, and the most severe cases likely will fail to respond to one or more drugs before the dermatologist hits on one that works for that particular acne case. Also, patients must avoid squeezing nodules or cysts under the skin, because this can cause the bacterial infection to spread and worsen.
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