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Solutions for Very Severe Acne

Solutions for Very Severe Acne Solutions for Very Severe Acne

The American Academy of Dermatology defines very severe acne as the kind that results in deep, painful cysts, nodules and inflammation--acne that can result in residual damage to the skin and noticeable scarring. Although severe acne can be successfully resolved with time and patience, it requires the help of a dermatologist who can recommend an appropriate treatment regimen. Very severe acne may be treated using physical methods that address one lesion at a time, or a prescription medication that treats acne systemically.


The oral medication isotretinoin is a type of retinoid derived from vitamin A. The AAD notes that a treatment regimen using isotretinoin in which the medication is taken once or twice a day for between 16 and 20 weeks is appropriate for deep, cystic acne and acne that doesn't resolve using any other method of treatment. Isotretinoin is almost always effective in resolving very severe acne after only one treatment. It can have troublesome side effects, such as extremely dry skin and eyes, temporarily thinning hair, stomach upset and headache. It can also cause birth defects. Women who take isotretinoin are carefully monitored by the U.S. Food & Drug Administration's iPledge program and must use two types of birth control and undergo routine pregnancy testing while taking the medication.

Oral Antibiotics

Oral antibiotics are also used to treat severe acne. These medications work by reducing acne-causing bacteria on the skin. Patients typically start with a high dosage, which is tapered once acne begins to disappear. One caveat of this type of treatment is that sometimes bacteria will become resistant to the oral antibiotic used to treat it, and another antibiotic must be used instead. The AAD notes that the oral antibiotics used most frequently to treat acne are doxycline, erythromycin, minocycline and tetracycline.

Physical Methods

A dermatologist may choose to treat cysts and nodules individually, particularly if there's the risk that the lesion may rupture and scar. Injections of a diluted corticosteroid dissolve the lesion over a period of three to five days. A doctor may also choose to surgically drain cysts that don't respond to treatment using sterile tools. The AAD warns that patients should never attempt to drain large cysts or nodules themselves, as this can worsen inflammation and lead to scarring.

Controlling Hormones

A method of treating very severe acne in female patients may include use of birth control pills (oral contraceptives) that suppress overactive sebaceous glands. Birth control pills may even be used as a method of controlling acne for a long period of time, notes the AAD, but they might not be appropriate for women who get migraines, who smoke, have blood-clotting disorders or who are over the age of 35. Oral contraceptives can cause certain side-effects, such as headaches, sore breasts, depression and nausea, warns the Mayo Clinic.

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