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How to Treat Severe Acne Vulgaris

We're getting close to wrapping up my series on the different acne types and how to treat them. If you don't know which kind of acne you have, take my quiz to find out. If your acne is mild, you can see my treatment suggestions here, and if it is moderate, you can check out treatments options here.


Severe acne vulgaris can be really painful, both emotionally and physically, but do not despair if this is your diagnosis! There are effective treatment options for you, too. But I'm gonna be straight with you: If this what you have, you must see a dermatologist, because there just isn't much that over-the-counter treatments can do for this kind of acne.

Just a quick refresher: Severe acne vulgaris consists of cysts and nodules. Nodules are solid, dome-shaped lesions. They're inflamed and painful, they extend into deeper layers of the skin, and they may cause tissue destruction that results in scarring. A cyst is a sac-like lesion containing liquid or semiliquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, may be severely inflamed, extends into deeper layers of the skin, may be very painful, and can result in scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic. If that describes your acne, see your treatment options when you read more.

  • Retinoids: This is the most common, and most proven effective treatment for severe nodulocystic acne. Retinoids come in two forms: oral and topical. Topical retinoids are better suited for mild to moderate acne, but for severe acne, an oral retinoid like Accutane can be a lifesaver as it actually reduces sebum production (often permanently). To read more about what retinoids are and what they can do for your skin, check out this post. To find out more about how Accutane works and decide whether or not it's for you, check out this post.
  • Hormone therapy: Since it is known that male hormones can play a role in the overproduction of sebum, females may benefit from certain combinations of estrogen medications such as birth control. In fact, as this study shows, hormonal birth control pills can significantly reduce the appearance of acne lesions in up to three-quarters of cases studied. To see more about the pill and acne, check out this post.
  • In-office options: Not as scary as it sounds, I promise! If you need immediate relief from a particularly painful or unsightly cyst, you can visit your doctor for a cortisone shot. It is injected directly into the inflamed lesion, and eliminates the painful swelling and redness in a jiffy. It's not a miracle cure, though, as it does not treat the underlying causes of acne. It is also painful, and too much cortisone can have unpleasant side effects like nausea and headaches. A doctor can also treat large and painful lesions with cryotherapy, which is essentially freezing them off using liquid nitrogen. This can be quite painful, but the cyst will disappear immediately. Side effects can be a bit rough, including peeling, blistering, and swelling, so this is best to only use in extreme cases of unbearable cysts.
  • Surgery: Not as scary as it sounds, but still only for use in extreme cases on cysts that have not responded to any other treatment. Your doctor will use a sharp instrument to drain the lesion of pus, oil, and bacteria, which relieves the pain and pressure while speeding up the healing time.
  • Some things to keep in mind if you are suffering from severe acne: First of all, there is hope! Do not despair if your skin doesn't respond to the same cleanser or antibiotics that worked wonders on your friend's skin. Everyone's skin chemistry is different. And I cannot stress this enough: You must see a doctor if you have cystic acne. I know it can be pricey, but think about all the money you will save on makeup if you address the source of the problem, not to mention the priceless mental relief of having clear skin. Let me know if anyone has tried any of the above treatments, as I would be interested to hear your stories.

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