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What Is Severe Acne?

What Is Severe Acne? What Is Severe Acne? What Is Severe Acne?


According to the American Academy of Dermatology, severe acne consists of deep cysts, inflammation and scarring. A dermatologist is the best person to supervise the treatment of someone with severe acne, since this skin condition can take many years to treat. This type of acne doesn't just cause physical signs and symptoms, but is also causes feelings of embarrassment and stress. Severe acne needs to be treated early to prevent complications like scarring and damage to tissue under the skin surface.

Acne Lesions

Typical acne lesions include whiteheads, blackheads and blister-like lesions called pustules. People with severe acne also have more serious acne lesions such as nodules and cysts. Both types of severe acne lesions often occur together and are inflamed, painful, extend deep into the skin and can lead to disfiguring scars. A nodule is a solid, dome-shaped lesion. A cyst, which is larger than a nodule, is a lesion filled with a liquid or semi-liquid substance made up of white blood cells, dead skin cells and bacteria. According to the American Academy of Dermatology, some acne investigators believe that cysts are not true acne lesions, but instead are misdiagnosed nodules that are severely inflamed.

Types of Severe Acne

There are four types of severe acne: acne conglobata, acne fulminans, nodulocystic acne and gram-negative folliculitis. Acne conglobata is a long-lasting and severe form of common acne that occurs more often in females. People usually experience this type of acne between 18 to 30 years of age. Acne fulminans, which occurs more often in young men, appears suddenly and may develop in a person with acne conglobata that is resistant to treatment. Nodulocystic acne is more common in men and is characterized by the presence of one or more cysts. Gram-negative folliculitis is a bacterial infection of the hair follicles. This type of severe acne can result from long-term antibiotic treatment.

Signs and Symptoms

Signs and symptoms of acne conglobata include deep ulcerations under nodules, abscesses under the skin, non-healing cysts or pustules, inflammation, large scars and the presence of widespread blackheads on the face, neck, trunk, upper arms or buttocks. Signs and symptoms of acne fulminans include nodules, cysts, fever and ulcerating acne lesions. This type of acne can also cause inflammation and aching of the joints with the hips and knee joints more often affected. Signs and symptoms of nodulocystic acne include the presence of potentially painful cysts located on the face, neck, scalp, back, chest and shoulders. The cysts can measure several centimeter across, and can grow together forming pockets of inflammation and tissue damage under the skin. Signs and symptoms of gram-negative folliculitis include pustules and cysts.


Acne conglobata is treated with antibiotics and an oral acne medication called isotretinoin. Isotretinoin is also referred to by the brand name Accutane. Treatment of this type of acne may extend over a period of years. Treatment of acne fulminans includes corticosteroids or anti-inflammatory medications to reduce inflammation and long-term treatment of isotretinoin. Nodulocystic acne is treated with isotretinoin, antibiotics and the injection of corticosteroid medication directly into the cyst. Large cysts that are resistant to treatment are drained and surgically removed. Gram-negative folliculitis is treated with isotretinoin and certain antibiotics.


Never attempt to pick, pop or squeeze acne lesions, especially severe types of acne lesions. Attempting to drain the lesion yourself can lead to infection, worsening of the acne lesions and scarring. Since severe types of acne lesions extend deep into the skin layers, you could damage tissue under the skin. A dermatologist can drain the lesion under sterile conditions.

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