Severe Acne: Causes And Treatment

Updated on: 4th July, 2023

Our skin has pores that have oil-secreting glands called sebaceous glands that secrete sebum. The sebum normally protects hair follicles and keeps the skin hydrated. But overproduction of this sebum and overgrowth of skin cells can cause plugging of these pores, leading to whiteheads, blackheads, and pimples. These clogged pores serve as fertile ground for the growth of commensal bacteria called Propionibacterium acnes, which gets trapped within them. This leads to infection and inflammation. In the absence of excessive production of sebum, the bacteria gets shed off with the outermost layer of skin Cysts are the most inflamed and ruptured type of acne, a flare-up of which causes a severe cystic acne.

The most common cause for increased secretion of sebum is hormonal changes, as seen in adolescence, during menstrual cycles, pregnancy, menopause, hormone therapy, and stress. Other factors influencing the sebum secretion are genetics, high levels of humidity and sweating, greasy cosmetics, consumption of oily, spicy foods and drugs like corticosteroids, lithium, etc.

Considering those, the main factor behind cystic acne still remains fluctuations in hormone levels. It is relatively uncommon, and more frequently seen in men than women. Though it can occur at any age, it is more likely to present during puberty. Subsequent life events causing hormonal fluctuations can increase the severity and prevalence of cystic acne breakouts, extending deep into the skin. The breakouts can present not only on the face, but also on other areas of the body like the neck, shoulders, chest, back, and buttocks.

Although cystic acne affects far fewer people, it can be painful, emotionally distressing, and can greatly affect a person’s self-image and self-esteem. Also, it requires extensive treatment and the struggle against it can be exhausting.

Now that we have discussed what is severe acne, let’s start discussing its common types, causes and treatments.

Acne Conglobata is rare and unusually severe form of nodulocystic acne. Painful cysts form and connect beneath the skin, creating visible, and even disfiguring scars. Significant damage is caused to the skin in the form of infected nodule acne, deeply inflamed abscesses, and scarring.

It occurs when follicles in the skin become inflamed from an infection caused by Gram-negative bacteria (that is, bacteria that do not turn blue with Gram staining). If not treated, all these severe forms of acne can prove detrimental to you, to your appearance and confidence.

While mild or moderate acne can be managed with the help of a doctor, severe acne needs a specialist. This is because expertise is needed to ensure that the nodules pimple and cysts leave no scars, and delicate control is required over the drugs used. Clear Skin Clinic offers guidance and treatment for dealing with severe acne.

There are certain triggers that aggravate an acne condition and lead to severe acne. These are as below:

Hormonal changes and imbalances during pregnancy, puberty, and menstrual cycle can lead to the enlargement of the sebaceous glands. This leads to the production of more sebum. Hormonal changes among women during midlife may also cause severe acne breakouts.

Some drugs like corticosteroids, lithium, and testosterone can trigger severe acne. 

Dairy products, carbohydrates and food high in sugar may aggravate an acne condition. Further studies are required to confirm whether dietary restrictions can control acne.

Although stress may not cause acne, it may worsen an already existing acne condition.

Isotretinoin is a prescription drug used as a first-time treatment for severe acne. It is derived from vitamin A that changes the shape of sebaceous glands, effectively stopping the flow of oil and, hence, showing immediate results. In most cases, it clears the skin completely and permanently within 5 months.

However, isotretinoin comes with potential adverse effects like chapped lips, joint pains, migraines, depression, liver damage, etc, and is also a risk to the fetus during pregnancy. Such side effects – except for chapped lips that is very common (and can be treated with good moisturizer and lip balm) – do not occur frequently. They are prevalent only in 5-10 percent cases. The remaining 90-95 percent can tolerate these side effects.

In any case, the treatment should always be conducted under the supervision of your dermatologist.

After applying photosensitizing cream topically, it is exposed to controlled pulses of red or blue LED light. It shrinks down the sebaceous glands, reducing the amount of oil and kills the bacteria, thus, minimizing the cystic acne lesions. This is a recently introduced method, that is effective over multiple sessions and is expensive.

A painless, but a costly procedure that uses a laser device to cleanse the pores by vacuuming and extracting excess oil and debris from inside, and to destroy the bacteria.

As we mentioned before, the course of treatment is extensive and, therefore, it’s advised that you take precautions to prevent severe acne, especially if you are already suffering from mild acne. Here’s how:

• Maintain a skin care routine (morning and night) using products that keep the pores clean and fight the bacteria. Use products that are non-comedogenic.
• Use sunscreen (SPF 30) every day.
• Drink lots of water.
• Avoid touching the skin, especially acne ridden skin.
• Shave carefully and soften the beard with soapy water before grooming, to avoid irritation to the skin.
• Shampoo regularly, especially if you have oily hair, to keep the sebum levels in control.

While these measures won’t help prevent acne if it’s hereditary, they will help alleviate symptoms.

Treating acne clinically is very important for good and permanent results

Yes, diet helps, but only in the post-treatment phase and recovery phase. Not treating acne for a longer period can leave you with scars and bad skin texture.

While acne can be treated with home remedies, the same self-care solutions may not be effective for controlling a severe condition. In such cases, it is essential to consult a general physician. You may be prescribed stronger medications to control the condition. If your acne cannot be controlled even with these medications, it’s time that you see a dermatologist.

Among some women, acne breakouts are common a week before menstruation. This condition persists for several decades, but stays under control with the use of contraceptives.

In addition, if you’re experiencing frequent acne flare-up, and it’s accompanied by other symptoms, you should seek immediate medical attention. Remember, acne breakouts or pimples can also be a sign of other underlying health issues. Your doctor can help identify this underlying reason after proper diagnosis and recommend you the right course of treatment.

For any doubts, treatment, and consultation regarding cystic acne, contact Clear Skin Clinic.

Book your appointment with a Clear Skin expert today!