The Best Treatment for Severe Acne

Treat Early to Prevent Acne Scars

Nov 7, 2009 Hanish Babu

The best treatment for severe acne is with oral retinoids or a combination of antibiotics and topical anti-acne medications.

Severe acne, with a high number of inflammatory pustules and nodules, should be treated promptly to prevent deep "ice pick" and hypertrophic acne scars.

In severe acne, there are pus filled lesions, formed fresh or from already existing papules, and a few nodules. Numerous red, painful, pus filled bumps and lumps are seen on the face, chest and back of the sufferers.

How is Severe Acne Treated?

As with other types of acne, there are specific and general measures to deal with the severe type of acne. In general, the specific treatment of inflammatory acne consists of oral retinoids, oral antibiotics, topical antibiotics, benzoyl peroxide and topical retinoids.

What is the Best Treatment for Severe Acne?

Oral isotretinoin is the single best treatment for acne. But it is a medication to be used with care and only under the supervision of a dermatologist. It is absolutely contraindicated in pregnancy .

Following is the treatment protocol for severe acne followed by most dermatologists:

Treatment is started with oral isotretinoin at a dose of 1 mg per kg body weight per day in males and non-pregnant females who are on double contraception during and two months after the medication. While on systemic retinoids, there is no need for any concomitant topical medications.
From family history, depth and severity of the inflamed acne bumps, if there is less chance for scar formation, and in those where oral retinoids are not advisable, the treatment is initiated with oral antibiotics (minocycline, tetracycline or doxycycline), with a gradual tapering of dosage over a period of six to eight weeks. In pregnancy, systemic treatment is advised only if severe pustular or nodular bumps are present. The drug of choice for inflammatory acne in pregnancy is erythromycin. All medications are best avoided in the first trimester of pregnancy, though.
Topical therapy of severe acne is the same as in the moderate type of acne. Morning topical clindamycin/erythromycin and evening benzoyl peroxide 5% gel is the preferred combination used in severe acne.
Once the pustules regress, topical benzoyl peroxide is replaced with topical isotretinoin.
Benzoyl peroxide and topical tretinoin cause irritation in some patients because of their peeling effect on the epidermis. The following steps will help reduce the irritation in sensitive individuals:

Tretinoin and benzoyl peroxide should be applied at night only.
A non-comedogenic, water based sunscreen is used during day time to avoid sun-sensitization.
If redness and scaling occur and skin becomes dried up, wash off the benzoyl peroxide or tretinoin cream/gel after two hours in the first week of application.
Once the skin starts tolerating the medication, overnight application can be retarted.
In these patients, lower strengths of benzoyl peroxide and tretinoin is used in the first two weeks, later shifting to higher strengths, if necessary.
At times, after two to three weeks of treatment, topical retinoids can cause a flare up. This indicates an inflammatory blowup of the acne bumps and is a good sign. There is no need to discontinue the topical application.
A post inflammatory reddish brown pigmentation is seen after treatment with benzoyl peroxide. This will gradually disappear on continued treatment. A sun protection cream should be used during daytime till the pigmentation subsides.

What are the General Measures in the Treatment of Severe Acne?

General measures include advice on skin care, washing, diet and lifestyle management. These and the tips on preventing new acne eruptions are the same for all types of acne.

What are the Complications of Untreated Severe Acne?

Untreated severe acne causes deep ice pick scars and hypertrophic scars in most patients. Post-inflammatory pigmentation is common, especially in the dark skinned individuals.

The best treatment for severe acne is a combination of oral retinoids or antibiotics and topical anti-acne medications. The treatment is individualized according to the extent, type of acne and sex and age of the patient.

Article Related to Best Treatment for Severe Acne

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

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 The Best Treatment for Severe Acne in General Medicine is owned by Hanish Babu. Permission to republish The Best Treatment for Severe Acne in print or online must be granted by the author in writing.

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