Severe Acne FAQ

Frequently Asked Questions on Inflammatory Pimples

Nov 8, 2009 Hanish Babu

Frequently asked questions on severe acne will explain the pathogenesis, the triggers, the best treatment available and the duration of the treatment of pimples.

Because of the predominance of inflammatory acne lesions, severe grade type 4 acne calls for prompt aggressive systemic and topical therapy. Most patients with severe acne are worried about the sequelae of the inflammatory bumps and suffer from anxiety and depression much more than the mild or moderate types of acne.

What Comprises Severe Acne?

Inflammatory pustules and deep acne bumps (nodules) are predominant in severe acne or acne grade 4. More than 100 comedones, or more than 50 papules or pustules and more than 5 nodules with a total count of more than 125 acne bumps comprise severe acne.

How is Severe Acne Formed?

The initial pathogenesis behind severe acne is similar to other types of acne, viz, hormone stimulation of the sebaceous glands, thickening of the follicular wall and blockage of the hair pores.

• In severe acne, the resident bacteria of the hair follicle, P.acnes, multiplies in the medium of the sebum causing breakdown of its components. This causes a chemical irritation, attracting inflammatory white blood cells known as neutrophils.
• Neutrophils release some chemical mediators and enzymes which cause the typical characteristics of an inflammatory reaction within the sebaceous glands and the associated hair follicles: calor, rubor, dolor, tumor and functio-lesa, meaning: heat, redness, pain, swelling and loss of function of the affected area.
• The inflammation and the resultant destruction of the follicular walls, sebaceous glands and the debris from the inflammatory reaction results in formation of pus filled bumps known as pustules.
• The wall and sheath of the gland and hair follicle expand in the dermis with the pus to form deep seated nodules.

What are the Triggers of Severe Acne?

The acne triggers inducing, aggravating and maintaining the acne are the same in severe acne as in other types of pimples. Picking at the acne bumps and application of topical steroids worsen severe acne.

What is the Best Treatment for Severe Acne?

The best treatment for severe acne is systemic retinoids. Because isotretinoin is a strong medication with local and systemic side effects and chances of fetal abnormalities, it is not usually advised to females of child-bearing age and during pregnancy. Females and their partners should use a double contraception (a barrier method plus contraceptive pills) while on retinoids.

How Long Should Severe Acne be Treated?

The duration of treatment varies from individual to individual and the response to anti-acne treatment. The average duration of treatment with oral isotretinoin is 18-20 weeks up to a maximum of 24 weeks. An interval of three months is given in between before a fresh course is started.

Those on oral antibiotics and topical applications may have to continue treatment for longer duration, until the active acne bumps stop appearing. Then, the dosage is reduced gradually, and stopped over a period of one to two months. The topical antibiotics are also stopped. Topical benzoyl peroxide is continued until no fresh acne bumps appear for a period of two to three months.

Maintenance therapy of healed severe acne is with topical tretinoin, usually with the 0.025% concentration. This is important in preventing recurrences. Any recurrence is dealt with the same way as new acne bumps and the best treatment for severe acne re-instituted at the earliest to prevent formation of acne scars.

Sources:

• Diane T, Gollnick H et al. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. J Am Acad Dermatol, 2009;60:S1-50.
• Simpson NB & Cunliffe WJ. Disorders of the Sebaceous Glands in Rook’s Textbook of Dermatology. 2004; 7: 43.1-43.75.

Disclaimer

The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purposes only.

The copyright of the article Severe Acne FAQ in General Medicine is owned by Hanish Babu. Permission to republish Severe Acne FAQ in print or online must be granted by the author in writing.

Severe Acne: Frequently Asked Questions.	How is Severe Acne Formed?	Topical Isotretinoin: Best Maintenance Therapy.
Inflamed Pimples: Benzoyl Peroxide Effective.	Severe Acne: Prone for Scarring.

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