Acne is the most common skin condition in the United States. Although this skin problem is prevalent among teenagers, people of all ages can experience it.
Acne can occur when oil and debris from dead skin get clogged in the pores of your skin.
The bacteria in the so-called "plug" made from oil or sebum, dead skin cells, and hair that get clumped together can cause the wall of the follicle to rupture. This in turn inflames or reddens the skin, in which pimples, whiteheads, and blackheads form.
Usually, acne emerges on the face, but they can also develop on other stubborn areas like the neck, shoulders, upper arms, chest, and back.
Today there are websites and apps that offer to help determine the severity of your acne or when you need to see a dermatologist.
Although they can offer some information, only a dermatologist can give a scientific assessment of your particular skin condition.
Now, let’s take a deeper dive to understanding acne.
Diagnosing Mild to Severe Acne
Dermatologists rate acne from grades 1 to 4, depending on the characteristics of your breakouts.
The acne grade assigned will determine the type of treatment your dermatologist will recommend.
Grade 1 (mild acne) No inflammation is found on the skin but is characterized by whiteheads, blackheads, and some small pimples, usually in the T zone. There is likely minimal redness or swelling. Over-the-counter (OTC) products are usually able to clear away this level of acne.
Grade 2 (moderate acne) Whiteheads and blackheads are more numerous. Skin also has papules and pustules. Moderate acne can also be treated by OTC products. However, a follow-up with your doctor is recommended if your condition doesn't improve after six to eight weeks.
Grade 3 (moderate to severe acne) Skin is more inflamed, reddish and filled with more papules and pustules. Some nodules can be found. Skin can bear some scars.
Grade 4 (severe acne) Grade 4 acne is also called cystic acne. Plenty of pustules, nodules, and cysts are present on the skin. Blackheads and whiteheads are also present. Inflammation and breakouts have extended to the neck, back, and upper chest.
A skin specialist will be able to tell you whether your condition is acne or another skin disorder as other ailments can trigger pimple formation like rosacea, milia, and sebaceous hyperplasia.
Your acne should be examined for the extent of inflammation, types of comedones (whiteheads and blackheads), the severity of breakouts, and coverage of the acne.
Your dermatologist will also classify your acne. Different classifications can include the following;
Papules – are small, red bumps that appear when the contents of a blocked pore spill out and bacteria affects nearby skin tissue, creating a lesion.
Pustules – look like papules but they contain yellowish fluid called pus.
Nodules – are often a result of the bacteria Cutibacterium acnes, which is also behind the development of papules, except that they cause infection deep within skin pores.
Cysts – are large, inflamed, red, and pus-filled, caused by infection deep within the skin. This is the most severe form of acne.
Non-inflammatory acne Whiteheads – are referred to as closed comedones because the pores are completely blocked.
Blackheads – are referred to as open comedones as the pores have no obstructions.
Next, let’s take a look at how acne is caused.
Acne Causes and Aggravators
In a survey released by eMediHealth in December 2019, 84% of 64 dermatologists ranked fluctuating hormones as the top cause of acne breakouts, followed by high levels of stress (76%), sugary food (64%), dairy products (56%), cosmetic products (53%), and certain medications (51%). Rounding up the top 10 were menstruation, poor diet, processed and packaged food, and poor hygiene.
The survey also asked its respondents to identify the factors that can make acne worse. About 79% ranked not checking with a dermatologist as the most common factor. This was followed by excessive washing or scrubbing (78%) and looking for quick fixes through self-medication (76%). Age, family history, working in a greasy work area, frequent pressure on the skin by items such as landline or mobile phones, helmets, and backpacks also heighten acne risk, according to Mayo Clinic.
So, now you’ve got the understanding of acne and the way it’s caused. How about how to treat it?
How to Treat Severe Acne Effectively
Over-the-counter (OTC) or non-prescription products are typically able to ease mild to moderate types of acne, though, if you have numerous nodules or cysts, OTC solutions may not be enough to clear your skin and relieve you of the pain and discomfort.
Dermatologists may advise you to take or undergo the following:
1. Topical prescription medication Topical medication includes creams, lotions, gels, and other products, which are applied to the skin. Your dermatologist will tell you which to use for your type of acne and skin.
Retinoids:prevent hair follicles from being clogged through skin exfoliation. They contain vitamin A, adapalene, tretinoin, and tazarotene.
○ Acne may flare up during the first few weeks of use but should subside with continued, consistent use. You‘ll likely be instructed to use it at night three times a week before being asked to apply it daily.
Nitric Oxide: is naturally produced by the human body to regulate blood pressure levels and blood flow. Dermatologists explore its antimicrobial properties after discovering that it can ease inflammation and cutaneous edema. Early attempts were limited, however, because nitric oxide is a gas in its normal state.
In recent years, scientists were able to formulate a nitric-oxide releasing gel that can cure moderate to severe acne by killing the bacteria and blocking the pathways that activate inflammatory processes. It's gentler than some retinoid drugs where acne treatment involves shedding and peeling.
Salicylic acid: treats acne, particularly whiteheads and blackheads, by penetrating the skin and clearing away excess oil. It also functions as an exfoliant and breaks down the bonds of dead skin cells, helping your pores unclog more effectively. Salicylic acid is known for providing the skin a soothing effect, thanks to its anti-inflammatory properties.
Mandelic acid: has antimicrobial properties to help fight acne, regulate sebum, and reduce the chances of future breakouts. It also works as an exfoliant, which helps dead skin cells shed more quickly. Mandelic acid is generally recommended for those with sensitive skin types because it’s gentle and less irritating when used.
Topical antibiotics: are antibiotics that are in ointment or cream form. They aim to stop the acne-causing propioni acnes bacteria from developing. They reduce inflammation and reduce pore blockage.
The most common acne antibiotics are erythromycin and clindamycin. Both of them usually come with benzoyl peroxide, which reduces the chance of antibiotic resistance. Topical antibiotics are usually prescribed for morning use, together with a retinoid at night.
Dapsone: is packaged in gel form and works to ease inflammatory acne. It's usually recommended for adult women with severe acne. Dapsone users may experience dryness and redness.
Azelaic acid creams: act against propioni acnes and help improve discoloration or dark marks left by acne.
Azelaic acid is potent when used with erythromycin. It's highly advisable for pregnant and breastfeeding women. However, such creams should be used cautiously as users may experience minor skin irritation and skin discoloration.
2. Prescription Oral Medication
Antibiotics: that fight skin infection such as tetracycline or macrolide may be prescribed by dermatologists.
Products with benzoyl peroxide would usually be recommended for those taking antibiotics so they won't develop antibiotic resistance.
Oral antibiotics work best when they're used together with topical retinoids
Birth control pills: were found to be effective against whiteheads, blackheads, pimples, and acne that the US Food and Drug Administration (FDA) approved certain oral contraceptives as acne treatment for women.
The pills contain both estrogen (in the form of norethindrone acetate) and progesterone, which lowers the amount of androgen production, which is responsible for excess sebum.
The four FDA approved pills are: Ortho Tri-Cyclen (norgestimate/ethinyl estradiol), Yaz (ethinyl estradiol/drospirenone), Estrostep FE (ferrous fumarate/norethindrone acetate/ethinyl estradiol).
Spironolactone: is also known as Aldactone and comes in tablet form that women can take with or without food. They function the same way birth pills do—they slow down the amount of androgen made by the ovaries.
Usually taken together with oral contraceptives, they’re highly recommended among women who suffer from breakouts during their monthly period.
Isotretinoin: is a strong retinoid that reduces oil produced by the body by shrinking the sebaceous glands. Unlike oral contraceptives and spironolactone, isotretinoin can be taken by both men and women.
You'll be required to enroll in the FDA-approved risk management program called iPledge if your doctor will ask you to take isotretinoin. This will ensure you are monitored due to the severe potential side effects of the substance, including ulcerative colitis, birth defects, and depression. Pregnant women are therefore prohibited from taking it.
Isotretinoin is the generic version of Accutane, which the FDA banned from distribution in 2009.
3. Procedural treatments
Corticosteroid: One cortisone shot can curb the inflammation of a cyst or nodule within 24 to 48 hours. It’s ideal for cystic breakouts and hormonal flare-ups. However, corticosteroid can leave a small depression in the skin, lasting for about two months, if administered at very high dosages. Loss of color in the skin and skin thinning are some other side effects.
Prednisone is a strong type of corticosteroid that’s used for severest forms of acne characterized by open sores known as acne fulminans.
Dermabrasion: This type of non-invasive treatment intends to remove or reduce acne scars through the help of a hand-held rotating device that "sands" the surface of the skin. The end result is smoother, younger-looking skin. Patients receive anesthetics for the treatment.
The downtime, or length of time when the skin is pinkish and sensitive, for dermabrasion is longer compared to microdermabrasion, which is done for more shallow acne.
Skin turns pink but returns to normal in 24 hours in microderm treatments, a procedure that involves the use of a wand to rub crystals on the face for exfoliation. Meanwhile, skin that underwent dermabrasion can stay pink for about three months.
Chemical peels: A chemical solution is applied to the skin for this type of procedure. It removes scars or discoloration so that a smoother, more youthful-looking layer of skin will emerge.
Chemical peels can be light (covering the epidermis), medium (epidermis and portions of the upper dermis), or deep (epidermis and mid to lower layer of the dermis), depending on the depth of your scars.
If you get a chemical peel, you’ll experience redness followed by scaling of the skin in about three days to a week after the treatment. You’ll be asked to avoid the sun for several months until new skin covers the treated area.
Phototherapy/Laser therapy: Dermatologists use light to treat stubborn acne. Propionibacterium acnes, which can get into clogged pores and cause acne, are sensitive to light. Wavelengths of blue and red light are used to kill bacteria and shrink the oil glands in your skin so that it produces less oil that obstructs your pores.
Your doctor may ask you to take medication that will make your skin more sensitive to light such as aminolevulinic acid and methyl aminolevulinate.
One to two follow-up treatments and a gentle skincare regimen featuringsevere acne kitsare necessary to achieve the best results for this type of therapy.
Acne surgery: Surgeries include
- Subcision or the insertion of a needle into the skin to loosen fibers below a scar for rolling and depressed acne scars.
- Punch excision or stitching a skin graft for “boxcar” or crater-like scars.
- Drainage of cysts or making a fine incision on the skin to remove the cyst and cauterizing the cyst wall.
If you're battling severe acne, you can reduce the risk of scarring and damage to your self-esteem by getting early and effective treatment. Severe acne can be stubborn, but modern treatments offer hope that accompanying discomfort can be alleviated and marks can be diminished. Besides consulting your doctor for the best skincare solution, seek moral support from your loved ones or a group that can understand your needs.
With patience, consistent treatment and confiding in a safe circle of friends or family to discuss how your acne is affecting you, you can triumph over