Last Updated on January 6th, 2020
Severe acne is usually something you cannot treat on your own. Medical supervision and strong medication are usually needed to resolve cysts, nodules, and keloidal acne. What doctors don’t tell you about treating severe acne, however, is that the side effects of treating severe acne usually include a new case of mild to moderate acne as the skin grows so fast it flakes and peels and new sebaceous glands make lots of skin oil. Medication may get rid of the worst symptoms of severe acne, but you will have to keep it from coming back.
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Most people who have acne have a mild to moderate form of acne called acne vulgaris, also known as common acne. This form of acne can cause whiteheads, blackheads, and pimples. If you squeeze a pimple with dirty fingers, you can drive acne bacteria down into the skin so that you have nasty cyst or nodule, but most people who have mild to moderate common acne only do this once.
The people who get the most severe forms of cystic, nodular, or keloidal (scar-covered) acne often did not have to deal with acne when they were children or teenagers. These much more severe forms of acne usually crop in young adulthood, especially in person who have darker skin, and usually in men. Even fair-haired men and women, however, can also develop severe acne.
In severe acne, it is not enough to keep pores open. In fact, the skin may completely grow over a pore, encasing acne bacteria inside. The immune system constantly attacks the bacteria, but they continue to grow and even spread beneath the skin and sometimes to other parts of the body. Severe acne is painful, it is disfiguring, it can’t be treated by cleansing the skin, and it can even move into joints and bones.
The best-known form of severe acne is cystic acne. It is mostly likely to strike people who have “perfect” skin. In cystic acne, healthy skin grows over an infected pore, trapping bacteria inside. The bacteria release chemicals that make surrounding tissues vulnerable to attack by the immune system, which destroys more and more of the lower layers of the skin. The cyst is visible and painful, but it cannot drain without being lanced (something you should never try at home) or treated with a topical retinoid such as Accutane, Retin-A, Adapalene, or Differin.
Another common form of severe acne is acne keloidalis nuchae. It differs from common acne in that it occurs in hair shafts, not in pores in facial skin, and that no acne bacteria are involved. In this form of acne, an ingrown hair gets stuck in its shaft and the immune system attempts to destroy it with inflammation. The skin seals the hair inside a pink scar that may take years to heal, or never heal at all. This problem is most common in males in the late teens and early twenties who have dark brown or black skin, who use old razors to shave, or who shave their heads with electric razors. This condition is also most commonly treated with Accutane, Retin-A, Adapalene, or Differin, all of which are dispensed under medical supervision.
Another form of acne, acne fulminans, strikes men who abuse testosterone or other steroids. This form of acne can strike both joints and the skin at the same time, causing disfiguring cysts and destroying joints. It cannot be treated with Accutane, Retin-A, Adapalene, or Differin, and only improves if testosterone and other steroid injections are discontinued.
Everyone who has severe acne needs medical care to get better. But there are things doctors don’t tell you about living well with severe acne while it is healing. Here are some of the most important tips for living with severe acne:
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