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Treating Severe Acne
Severe acne is characterized by deep cysts,
inflammation, extensive damage to the skin and scarring. It requires an
aggressive treatment regimen and should be treated by a dermatologist.
Severe, disfiguring forms of acne can require years of treatment and may
experience one or more treatment failures. However, almost every case of
acne can be successfully treated.
Physical methods and prescription medications that dermatologists use to
treat severe acne include:
Drainage and Surgical Excision
Some large cysts do not respond to medication and may require drainage
and extraction. Drainage and extraction, or “acne surgery” as it is also
called, should not be performed by patients. Dermatologists are trained
in the proper technique and perform acne surgery under sterile
conditions. Patient attempts to drain and extract comedones by squeezing
or picking, can lead to infection, worsening of the acne and scarring.
Interlesional Corticosteroid Injection
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| Severe acne
requires an aggressive treatment regimen and should be treated by
a dermatologist. |
| Photo used with
permission of the American Academy of Dermatology National Library
of Dermatologic Teaching Slides and the Sulzberger Institute for
Dermatologic Education |
When an acne cyst becomes severely inflamed,
there is a good chance that it will rupture and
scarring may result. To treat these severely
inflamed cysts and prevent scarring,
dermatologists may inject such cysts with a
much-diluted corticosteroid. This lessens the
inflammation and promotes healing. An interlesional
corticosteroid injection works by "melting" the cyst over
a period of 3 to 5 days.
Isotretinoin
Isotretinoin is a potent drug reserved for treating severe
cystic acne
and acne that has proven itself resistant to other medications.
Isotretinoin is a synthetic (man-made) retinoid (form of vitamin A) that
comes in pill form. It is usually taken once or twice a day for 16 to 20
weeks.
Today, it is the most effective acne treatment available because it is
the only acne treatment that works on all four factors that predispose a
person to acne—excess oil production, clogged skin pores,
P. acnes and
inflammation. The remissions achieved with isotretinoin usually last for
many months to many years. For many patients, only one course of
isotretinoin therapy is needed.
The effectiveness of isotretinoin in treating severe acne is shown in
the following before-and-after photos:
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Photos
used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides and the
Sulzberger Institute for Dermatologic Education |
|
Severe acne before treatment with isotretinoin |
After treatment with isotretinoin |
|
While isotretinoin is the most effective acne treatment available, it
cannot be prescribed to everyone due to a number of potential side
effects—some serious. One of the most serious side effects is the
potential to cause severe birth defects in a developing fetus. For this
reason, the U.S. Food and Drug Administration (FDA) requires that women
not be (or become) pregnant while taking isotretinoin. FDA regulations
require women of childbearing age to take 2 pregnancy tests prior to
beginning isotretinoin therapy and use 2 forms of birth control for 1
month before therapy begins, while taking the drug and for 1 full month
after therapy. It is also important that women not breast feed during
this time. Women who wish to become pregnant after taking isotretinoin
should talk to their dermatologist and gynecologist about when it is
safe to get pregnant after receiving isotretinoin therapy.
Other possible severe side effects that may occur while taking
isotretinoin include:
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Severe pain in the chest or abdomen
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Trouble swallowing or painful swallowing
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Severe headache, blurred vision or dizziness
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Bone and joint pain
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Nausea or vomiting
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Diarrhea or rectal bleeding
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Depression
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Dryness of the skin, eyes and nose
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Thinning hair
If any side effect occurs, the patient’s dermatologist or other
healthcare practitioner should be contacted immediately because some of
these side effects can lead to serious health problems.
While taking isotretinoin, patients are regularly monitored for side
effects through follow-up visits. For most people, these side effects
are tolerable and not a reason to discontinue therapy before remission
is achieved. However, it is important to keep appointments for follow-up
visits because monitoring can reveal conditions that a patient might not
notice. For example, a patient may not realize a rapid increase in bad
cholesterol that is detected through a blood test.
The decision to use isotretinoin should be made jointly by patient and
dermatologist. When used with all due caution under close medical
supervision, isotretinoin can resolve severe acne that has not responded
to other therapy. It has proven especially effective in resolving cystic
acne, a severe form of acne that usually does not respond to other
therapies.
For a substantial number of patients, one course of isotretinoin therapy
is all they will ever need. A small number of patients require more than
one course of isotretinoin therapy to control severe acne.
It is important to take isotretinoin as prescribed—even if the skin
clears before all of the pills have been taken—to prevent relapse. At
the end of an effective course of isotretinoin therapy, all or most of
the acne lesion will have cleared. Patients may notice residual
erythematous (reddish) macules (flat spots) where acne lesions were
present. These macules are not scars, and they will fade in 6 to 8
weeks.
After therapy, patients should continue to follow the
Skin Care
Guidelines for People with Acne.
Oral Antibiotics
Oral antibiotics have been a mainstay of therapy for severe acne for
many years. Like topical antibiotics, oral antibiotics work to reduce
the P. acnes population (a contributing factor in acne), which, in turn,
decreases inflammation. Treatment with oral antibiotics usually begins
with a high dosage, which is reduced as the acne resolves. Over time,
the P. acnes bacteria can become resistant to the antibiotic being used
to treat it. When this happens, another antibiotic can be prescribed.
Numerous studies support the effectiveness of the following
broad-spectrum oral antibiotics that are used to treat acne in the
United States: doxycline, erythromycin, minocycline and tetracycline.
For information about each of these oral antibiotics, see
Prescription
Acne Medications.
Oral Contraceptives
Oral contraceptives have been shown to effectively clear acne in women
by suppressing the overactive sebaceous glands. Oral contraceptives can
be used as long-term acne therapy; however, this medication should not
be prescribed to women who smoke, have a blood-clotting disorder, are
older than 35 or have a history of migraine headaches—without the advice
of a gynecologist.
Spironolactone, a synthetic steroid, may be used in combination with
oral contraceptives to treat acne in adult females. Spironolactone
inhibits androgen production. Side effects include irregular
menstruation, breast tenderness, headache and fatigue.
More Information
Acne Severity
Acne Therapies
Severe Acne (4
Types)
Acne Skin Care Guidelines |
