The Best Treatment for Severe Acne: Treat Early to Prevent Acne Scars

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

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

Severe Acne
Severe Acne: Early Treatment Prevent Scar

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 humps are seen on the face, chest and back.

 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:

  1. Treatment is started with oral isotretinoin at a dose of 1-2 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.
  2. 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 6-8 weeks. In pregnancy, only if severe pustular or nodular bumps are there is systemic treatment advised. The drug of choice for inflammatory acne in pregnancy is erythromycin. All medications are best avoided in the first trimester of pregnancy.
  3. Topical therapy of severe acne is 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.
  4. Once the pustules regress, topical benzoyl peroxide is replaced with topical isotretinoin.
  5. 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 sun screen is used during daytime to avoid sun-sensitization.
    • If redness and scaling occur and skin becomes dried up, wash off the benzoyl peroxide or tretinoin cream/gel after 2 hours in the first week of application. Once the skin starts tolerating the medication, overnight application can be restarted.
    • 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 2-3 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 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 advices on skin care, washing, diet and life style 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.

Published by Dr Hanish Babu, MD on 28th May, 2018

The information given in this article is for educational purpose 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, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

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