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What Is Severe Acne?

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Updated May 29, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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Severe acne can be treated with the right medications.

Photo © A.D.A.M.
Question: What Is Severe Acne?
There are many ways to classify acne, but you may be surprised to know that there is no standard way to categorize acne. No matter, though, because for most of us, just knowing if acne falls into the mild, moderate or severe category is exact enough. Knowing which group your acne falls into can help you tremendously by ensuring you get the right treatment for your skin.
Answer:

Severe inflammatory acne is the most serious form of acne vulgaris. Sometimes it's called cystic acne, nodular acne, or nodulocystic acne. It doesn't matter which name you use -- severe acne is something that should be taken seriously. But the good news is it can be treated.

What sets severe acne apart from milder forms is the amount of inflammation. You'll have lots of papules, pustules, and comedones, but you'll also have nodules and/or cysts. Blemishes often feel like they are in deeper layers of the skin, and they can be painful too.

Severe acne can happen at any age, and in both men and women. And those breakouts can happen on other areas of the body. Many people get breakouts on their back, neck, chest and shoulders as well as the face.

While generally severe acne means inflammation, some people have severe comedonal acne instead. The difference is, instead of inflamed nodules and cysts, you'll have lots of non-inflamed blackheads and closed comedones. Again, there will be a large number of breakouts and they will be widespread.

Here are some signs that your acne falls into the severe category:

  • My blemishes are widespread, and cover a significant part of my face and/or body.
  • I have a lot of redness and inflammation on my skin.
  • Many of my blemishes are deep, inflamed, and painful.
  • I have scarring.
  • Over-the-counter treatments have done nothing to improve my skin.

If any of these statements describe your skin, you may have severe acne. (Sometimes it's hard to determine where your acne falls on the severity scale; that's OK. If you've tried OTC acne treatments for 12 weeks with little or no improvement, it's time to see a dermatologist, regardless of how severe your acne is.)

Severe acne easily leads to scarring, so it's critical that you get treatment right away. But acne of this type won't respond to any over-the-counter treatments; don't even waste your time and money there. Instead, go to a dermatologist ASAP. Severe acne should be treated aggressively, often with multiple medications, to get it under control as soon as possible.

There are so many treatment options available to us today that can help improve even severe acne. But it's probably not going to be a quick or easy matter. It takes time and careful treatment to get your acne under control. Be prepared to follow the treatment regimen your dermatologist sets for you exactly.

Severe acne can cause damage to both the skin and the psyche. This type of acne often causes scarring, even with careful treatment. Once your acne is fairly under control, your dermatologist can help you devise a treatment plan to improve scarring.

And don't downplay how demoralizing and isolating acne of any severity can be. Acne can definitely batter your confidence. Getting treatment can help you feel better. But if you feel acne is completely overwhelming your life, ask your physician for help.

Severe acne is a tough problem, but it can be managed. If you're willing to put the time in, work with your dermatologist, and faithfully follow your treatment plan, you can get great improvement of your skin. So don't give up... there is hope!

Next Steps:

Severe Acne Treatment Options

Video: How To Treat Cystic Acne

Sources:

Feldman S, Careccia RE, Barham KL, Hancox J. "Diagnosis and Treatment of Acne." Am Fam Physician. 2004 May 1;69(9):2123-2130.

"Treating Severe Acne." AcneNet. American Academy of Dermatology, 2011. Web. 24 Apr 2012. http://www.skincarephysicians.com/acnenet/treatsevereacne.html

United States. NIAMS. Questions and Answers About Acne. Bethesda, MD: National Institutes of Health, 2006.

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