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A Guide to Severe Acne Treatment

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Updated: 11/01/2011 8:04 pm

Acne, a common skin disease that affects 40 to 50 million Americans, comes in a variety of appearances. It affects mainly teenagers, but it can also begin or persist into your 20s, 30s, and later. Acne's psychological impact can't be ignored -- it is associated with higher rates of anxiety, depression, and unemployment.  

If you have severe acne, it can greatly affect the quality of your life. You should know that you have treatment options and most cases of acne can be successfully treated. The key is to work with your dermatologist to set up a treatment plan that is tailored to your specific needs.

The Signs of Severe Acne

The exact cause remains a mystery, but there is a tendency for acne to run in families. If you have symptoms of acne and have a parent or sibling that had severe acne with scarring, you may want to see your dermatologist to discuss treatments for severe acne.

Severe acne is a disfiguring disease that can often result in significant scarring. Scarring often occurs after the healing of deep acne lesions.

What does severe acne look like? People with severe acne may have:

  • Deep, painful, or tender cysts
  • Nodules
  • Inflammation
  • Skin surface irregularities
  • Scarring  

Treatment for Severe Acne

A powerful drug, isotretinoin, is reserved for treating the most severe cases of inflammatory acne. People with moderate to severe acne that fails to respond to other medications, including antibiotics, and those who have aggressive, painful, disfiguring acne may be referred for oral isotretinoin (Accutane, Amnesteem, Claravis, or Sotret) treatment.

Isotretinoin, derived from vitamin A, is an effective treatment because it targets acne by halting oil production and decreasing inflammation that can lead to scarring. It has the potential to suppress acne over a long-term period and typically needs to be taken for three to six months.

"In the worst cases, we do use isotretinoin," says Patricia Farris, MD, dermatologist in private practice in Metairie, La., and clinical associate professor in the department of dermatology at Tulane University School of Medicine in New Orleans. "It's a miracle for people who have stubborn acne."

Side Effects of Isotretinoin

While it can be an effective acne treatment, isotretinoin has potentially damaging side effects that you should know about.

One serious side effect is causing severe birth defects to unborn fetuses, so the FDA requires women of childbearing age to use birth control before, during, and one month after therapy.

The FDA also warns that using isotretinoin may be linked to depression, psychosis, and, in rare cases, suicidal thoughts or suicide attempts.

While taking isotretinoin, you will be monitored for side effects through at least monthly follow-up visits. In 80 out of 100 people, isotretinoin clears up severe acne. One-third of patients relapse after successful isotretinoin treatment. Usually, this is noted in the first year after stopping therapy. Your doctor may recommend another course of isotretinoin or another treatment, depending on the severity of your acne.

Other Severe Acne Treatment Options

What can be done to treat severe acne?

  • If you have large, persistent cysts that do not respond to medication, you may decide to try drainage and extraction, sometimes referred to as "acne surgery." This procedure may reduce the risk of scarring. It's important that you go to a dermatologist who can perform this in-office procedure.
  • To treat severely inflamed acne cysts, ease pain and prevent scarring, your dermatologist may recommend an anti-inflammatory steroid injection at the affected area. Intralesional corticosteroid injections work to reduce inflammation, and acne cysts typically shrink within 2 to 5 days after injection.
  • A newer therapy to treat severe acne is photodynamic therapy (PDT). PDT is a non-invasive therapy that uses light treatments to destroy bacteria that cause acne breakouts. Recent studies have supported the effectiveness of MAL-PDT, a special type of photodynamic therapy, to treat moderate to severe inflammatory acne.

In many patients, acne is a disorder in which symptoms typically recur over years. So finding a treatment regimen that can be sustained over time is a critical part of managing acne.

Tips

  • Don't wait. If you have signs of acne, set up an appointment with your doctor or dermatologist. The sooner you start treatment, the sooner you will start to see results.
  • Don't ignore side effects. If you're experiencing side effects from prescribed medications, speak up to yourdermatologist.Individuals react to drugs differently -- your treatment plan must work for you.
  • Watch your mood. Acne is associated with higher rates of anxiety and depression. If you are experiencing any symptoms, talk to your doctor and seek treatment.
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