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Severe acne (grades 3-4) is a challenging skin condition that must be treated with care. Because it doesn't heal as easily as mild acne and blemishes can remain for a longer period of time, people with this level of acne can battle with anxiety, or even low self-esteem and depression.

Skin with severe acne is inflamed with significant amounts of redness. This causes painful breakouts which can be larger than five millimeters, and lesions that are widespread compared to mild acne. This can lead to scarring, which causes those afflicted to look for solutions capable of keeping their skin condition under control.

A natural impulse among severe acne sufferers is to self medicate using natural, organic, or homeopathic treatments. However, when acne is especially severe, the process can drag on forever and you end up experimenting longer than you expected. 


Types of Severe Acne

Nodulocystic (or cystic) acne

Cystic acne forms tender, inflamed, fluid-filled nodules beneath the skin. Meanwhile, large red swollen bumps appear on the skin's surface. Some of the bumps may contain one or two pustules, which contain yellowish fluid.

Acne conglobata

Acne conglobata is a rare but severe type of nodulocystic acne wherein large, painful cysts develop under the skin and connect with one another, producing scars. Comedones and cysts contain pus with foul odor, and can appear in the face, chest, shoulders, upper arms, back, thighs, and buttocks.

Gram negative folliculitis

This condition develops mostly in people who currently have acne, leading most to believe their condition was simply worsening. 

Gram-negative organisms infect the follicles of the skin and makes them inflamed, and may occur in people who underwent long-term antibiotic treatment for acne. Bacteria causing this type of acne may also be acquired from contaminated water or HIV infection.

Acne fulminans

Acne fulminans is considered the most severe kind of acne. Deep ulcerations or large open sores can be found on individuals with this acne condition. 

Patients with this type of acne suffer from scarring and psychosocial distress. They’re usually given steroids and isotretinoin, both taken orally.


Natural Solutions

Your frustration may cause you to try home or natural remedies usually featured in health websites. However, there's no credible research or evidence at all that suggests these organic ingredients will help with the management of your severe acne issues. They might not even be tolerated by your skin.

Tea tree oil

Tea tree oil is also known as melaleuca oil, named after the native Australian plant. Dermatologists say that it attacks the Cutibacterium acnes bacteria, which also participates in acne formation, although it's also present in normal skin. However, it's only best for mild to moderate types of acne. It also works more slowly than benzoyl peroxide.

Dermatologists suggest using products containing the essential oil rather than using it in its pure form. 

Although it's known to be gentler than benzoyl peroxide or salicylic acid, tea tree oil can still cause irritation for people with eczema or sensitive skin.

Apple Cider Vinegar

Through its acetic, citric, succinic, and lactic contents, Apple cider vinegar can kill the skin bacteria Proprionobacterium acnes which causes acne breakouts. Citric acid also reportedly helps with skin cell turnover, which leads to reduction in age spots and wrinkles.

But it's acidic, so while it has been known to treat wounds, it can also irritate or burn your skin, especially when you apply it undiluted. 

Green Tea

Green tea is known to have polyphenols, or antioxidants that are anti-inflammatory. It also helps reduce sebum production, so it's highly considered as a natural remedy. However, green tea as a drink is more preventive against acne and can only make existing blemishes less inflamed. It might work more aggressively as an ingredient of topical cream.

Green tea also has zinc, which is associated with acne treatment. But the effects of zinc on acne are only modest based on studies carried out so far. Zinc can also cause diarrhea and bloating besides leaving a metallic taste in your mouth.

Witch Hazel

Witch hazel got its name from being a flexible (from Middle English word wych) plant that highly resembles the hazelnut. The extract from the bark and leaves of this shrub, which is native to North America and Japan, contains compounds called tannins that help remove excess oils from your skin due to its astringent properties while reducing the growth of bacteria which can clog pores. It appears as hammamelis virginiana water in the label of toners.

However, dermatologists warn that witch hazel can irritate the skin of people with rosacea and sensitive skin. Tannins and ethanol used in processing the plant's extracts after the distillation process cause the irritation. 



Dermatological Solutions

Look for over-the-counter (OTC) acne treatment products with active ingredients approved by the Food and Drug Administration if you've tried home-made or organic remedies for your mild to severe acne but see no improvement. 

Unlike natural remedies, there’s plenty of clinical evidence and research that show that these products are able to significantly manage and reduce acne.

Dermatologists often prescribe topical medications including:

Salicylic acid

You will find salicylic acid as an active ingredient in acne washes and spot treatments. Made from willow bark, salicylic acid is most potent against cystic acne.

It's a beta hydroxy acid (BHA), which is a keratolytic or exfoliating agent. It's oil-soluble, so it's able to penetrate deeper into your skin's pores. It also loosens desmosomes, the membranes connecting adjacent cells in the skin's outer layer, and helps unclog pores.

Salicylic acid concentrations in the 1.5% to two-percent range are best when you have severe acne. Choose lower concentrations of 0.5% to one percent if you have both acne-prone and sensitive skin, as salicylic acid can dry up your skin.

Mandelic acid

Meanwhile, Mandelic acid, which comes from bitter almonds, is an alpha hydroxy acid type of exfoliant. It's water soluble so it can only work on your epidermis. It breaks squames or the bridges between mature, dead skin cells, where comedones develop. Open comedones are blackheads while closed comedones are whiteheads. These pore blockages are the beginnings of all inflamed pimples.

Unlike salicylic acid, mandelic acid doesn't penetrate as deeply into your skin due to its larger molecular structure (two times larger than glycolic acid). This makes it less likely to cause itchiness or stinging so it's highly recommended for people with sensitive skin and darker skin tones. 

Mandelic acid can cause skin to be more photosensitive so dermatologists advise users of this treatment to also apply sunscreen daily.

Nitrogen/Nitric Oxide

A 2015 study by a team from the University of California-Los Angeles and Albert Einstein College of Medicine showed that nitric oxide can be used to eliminate the acne growth-stimulating Proprionobacterium acnes bacteria and block inflammasomes, which activate the inflammation process in the skin.

A growing number of doctors are discovering nitric oxide as a key to preserving not just youthful skin but also overall health.

If OTC acne solutions still do not ease your acne, consult a dermatologist. Skin specialists will be able to more effectively determine what type of skin affliction you have, its severity, and write a prescription for medication.

Be sure to check with your health insurance plan before setting an appointment to understand what will be covered in relation to your skin treatment. Without proper insurance coverage, the consultation and medication can sometimes be very expensive. 

It would also help to do some research regarding the potential side effects of orally ingested acne medications such as Accutane.


Tips for Managing Severe Acne

Whether you're about to consult a dermatologist or are on your way to healing through prescribed medication, here are some do's and don'ts to remember:

  • Follow a skincare regimen that includes a medicated cleanser and treatment (using over-the-counter or doctor-prescribed ingredients). Use a moisturizer to protect your skin from dryness or dehydration, and an SPF to protect from excessive sun exposure.
  • Avoid touching your face using your hands. If you need to apply a cleanser, use your fingertips.
  • Don't attempt to scrub your acne. The harsh action may just cause your skin to produce more oil and produce more black/whiteheads and pimples.
  • Instead of an oil-based concealer, use a water-based product that's a shade darker than your natural skin tone and apply a layer of foundation before patting on loose—not pressed—powder if you need to attend a special occasion and wear makeup.