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A Guide to Severe Acne Treatment

WebMD Feature
Reviewed by Debra Jaliman, MD

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.

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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.

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