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What Is Severe Acne?

Dr. Dhananjay Chavan

Oct 6, 2018

Acne can be very annoying, right? Tainting the perfection of your clear, unblemished skin. While mild acne or a pimple can also seem drastic to an adolescent, cystic acne is the most severe form of acne, which is much more difficult to treat.

Our skin has pores that have oil-secreting glands called sebaceous glands which secrete sebum, that normally protects hair follicles and keeps the skin hydrated. But overproduction of this sebum and overgrowth of skin cells can cause plugging of these pores, leading to whiteheads, blackheads, and pimples. These clogged pores serve as fertile ground for the growth of bacteria, and commensal bacteria called Propionibacterium acnes which otherwise gets shed off with the outermost layer of skin gets trapped within them, leading to infection and inflammation. Cysts are the most inflamed and ruptured type of acne.

The most common cause for increased secretion of sebum is hormonal changes, as seen in adolescence, during menstrual cycles, pregnancy, menopause, hormone therapy, and stress. Other factors influencing the sebum secretion are genetics, high levels of humidity and sweating, greasy cosmetics, consumption of oily, spicy foods and drugs like corticosteroids, lithium, etc.

Considering those, the main factor behind cystic acne still remains fluctuations in hormone levels. It is relatively uncommon, more frequently seen in men than women; and though can occur at any age, it is more likely to present during puberty. Subsequent life events causing hormonal fluctuations can increase the severity and prevalence of cystic acne breakouts, extending deep into the skin. The breakouts can present not only on the face, but also on other areas of the body like the neck, shoulders, chest, back, and buttocks.

Although cystic acne affects far fewer people, it can be painful; emotionally distressing and can greatly affect a person’s self-image and self-esteem. Also, it requires extensive treatment and the struggle against it can be exhausting.

The common types of severe cystic acne are:

  • Nodulocystic acne:

This is characterized by bumps filled with pus, fluid, or some other material, which are difficult to treat.

It’s a rare and unusually severe form of nodulocystic acne. Painful cysts form and connect beneath the skin, creating visible and even disfiguring scars. Significant damage is caused to the skin in the form of infected nodules, deeply inflamed abscesses, and scarring.

  • Acne fulminans:

This is most commonly seen in males during puberty, identified by sudden and severe inflammation affecting the entire body. The person may also present with fever, joint pain, bleeding ulcers, weight loss, etc.

  • Gram-negative folliculitis:

It occurs when follicles in the skin become inflamed from an infection caused by Gram-negative bacteria (that is, bacteria that do not turn blue with Gram staining). If not treated, all these severe forms of acne can prove detrimental to you, to your appearance and confidence.

While mild or moderate acne can be managed with the help of a doctor, severe acne needs a specialist. This is because expertise is needed to ensure that the nodules and cysts leave no scars, and delicate control is required over the drugs used. Clearskin Clinic offers guidance and treatment for dealing with severe acne.


How to treat cystic acne?

Here’s what’s available to treat cystic acne:

  • Benzoyl peroxide

Available over-the-counter as lotion, cream, gel, cleansing liquid, and bar, benzoyl peroxide has been the popular treatment for treating acne of any severity for over 50 years. It breaks up comedones (whiteheads and blackheads) and also kills the bacteria when used once or twice a day. Based on your skin type, your dermatologist will recommend a particular formulation.

  • Topical retinoids

Creams, lotions, or gels with a retinoid, a form of vitamin A, are available on prescription, which can help unplug your pores and facilitate antibiotics to work better.

  • Oral antibiotics

These are useful in controlling bacterial infection and reducing inflammation. They are to be used for a short duration to avoid bacterial resistance, and alongside topical creams for optimal effectiveness.

  • Isotretinoin

Isotretinoin is a prescription drug used as a first-time treatment for severe acne. It is derived from vitamin A that changes the shape of sebaceous glands, effectively stopping the flow of oil and so showing immediate results. In most cases, it clears the skin completely and permanently within 5 months. However, it comes with potential adverse effects like chapped lips, joint pains, migraines, depression, liver damage, etc, and is also a risk to the fetus during pregnancy. That’s why the treatment should be conducted under the supervision of your dermatologist.

  • Birth control pills

When the cause for acne is hormonal fluctuations, birth control pills containing synthetic estrogen and progesterone hormones can be used for 6 months to suppress sebum production.

  • Spironolactone

Spironolactone is an oral drug that blocks androgen, the male hormone that is responsible for increasing sebum production, resulting in clearer skin.

  • Steroid Injections

Injecting a corticosteroid medication like triamcinolone directly into a cyst, on face, chest, and back, can help reduce inflammation and prevent scarring. The acne cysts will usually shrink within eight hours and improve over several days. Because they only treat the inflammation, they should be used in conjunction with another treatment to treat the actual infection in the cysts. 

  • Incision and Drainage

If your cysts are large, inflamed and painful, your dermatologist may opt to cut them open with a small incision and drain out the infected fluid. The procedure is quick and painless, but there are chances of recurrence even after complete drainage.

  • Photodynamic therapy

After applying photosensitizing cream topically, it is exposed to controlled pulses of red or blue LED light. It shrinks down the sebaceous glands, reducing the amount of oil and kills the bacteria, thus minimizing the cystic acne lesions. This is a recently introduced method, that is effective over multiple sessions and is expensive.

  • Isolaz

A painless, but a costly procedure that uses a laser device to cleanse the pores by vacuuming and extracting excess oil and debris from inside, and to destroy the bacteria.

As we mentioned before, the course of treatment is extensive and so it’s advised that you take precautions to prevent severe acne, especially if you are already suffering from mild acne. Here’s how:

  • Maintain a skin care routine (morning and night) using products that keep the pores clean and fight the bacteria. Use products that are non-comedogenic.
  • Wear a sunscreen (SPF 30) every day.
  • Drink lots of water.
  • Avoid touching the skin where possible.
  • Shave carefully and soften the beard with soapy water before grooming, to avoid irritation to the skin.
  • Shampoo regularly, especially if you have oily hair, to keep the sebum levels in control.

While these measures won’t help prevent acne if it’s hereditary, they will help alleviate symptoms.

For any doubts, treatment, and consultation regarding cystic acne, contact us at ClearSkin Clinic.

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