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A Guide to Severe Acne Treatment

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WebMD Feature
Reviewed by Debra Jaliman, MD

You don't have to put up with severe acne and run the risk of getting scars on your face. There are lots of treatments that can bring your breakouts under control. The key is to work with your dermatologist to tailor a treatment plan to your specific needs.

Isotretinoin for Severe Acne

Isotretinoin is a powerful drug that's used to treat the most severe cases of acne. Your doctor may recommend this drug if you have severe acne that doesn't get better with other medications, including antibiotics.

The drug is derived from vitamin A. It targets your acne by stopping the production of oil and decreasing inflammation that can lead to scarring.

Isotretinoin may be able to control your acne long-term and typically needs to be taken for 15 to 20 weeks.

Side Effects of Isotretinoin

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

One serious side effect is that it can cause severe birth defects. The FDA requires women of childbearing age to agree in writing to use birth control before, during, and for a 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 checked by your doctor for side effects through at least monthly follow-up visits.

In 8 out of 10 people, isotretinoin clears up severe acne. But one-third of people may develop acne again after successful isotretinoin treatment. If this happens to you, usually you'll spot the return of your acne in the first year after you finish the treatment. Your doctor may recommend another round of isotretinoin or another treatment, depending on how severe your acne is.

Other Severe Acne Treatment Options

Besides isotretinoin, you may also treat your severe acne with a procedure that drains and removes large acne cysts. This procedure may reduce the risk of scarring.

Your doctor may also recommend an anti-inflammatory steroid injection to treat inflamed acne cysts. Your cysts may shrink 2 to 5 days after the injection.

Another option you can consider is photodynamic therapy (PDT). PDT uses light treatments to destroy bacteria that cause acne breakouts.

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