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Severe Acne: Types and Treatment Options

Mary Lucas, RN

Medically reviewed by Mary Lucas, RN

Written by Our Editorial Team

Last updated 10/21/2021

If you’re searching the web for information on severe acne, you’re clearly tired of dealing with skin problems. Acne of all types is disruptive and troubling, but when it’s severe, it can jeopardize your quality of life. 

This isn’t one or two pimples — severe acne is the type of acne that makes you want to hide away from the world. It hurts, makes you self-conscious, and can scar you for life. 

At some point, your struggles with acne should lead to a healthcare provider. And sometimes that doesn’t happen until you’ve tried every single drug store solution, every cleanser and skincare cream. 

But serious acne sometimes requires the big guns -- such as prescription acne treatment.

What Is Acne, Exactly?

Sure, you know what common acne is. It’s pimples. But do you know what’s happening beneath your skin? 

According to an article published in the Indian Journal of Dermatology, acne vulgaris may be the most common skin condition, but that doesn’t mean everyone knows what they need to know about it. 

According to American Family Physician, acne is caused by abnormal dead skin cell build-up, which obstructs or “clogs” your pores, making it impossible for sebum — nature’s moisturizer — to get onto the surface of your skin. 

The clogged pore is further irritated by the bacteria Propionibacterium acnes, which makes it inflamed and irritated. The result of all of this: A pimple. And when this happens consistently, it’s safe to say you have acne.

Not all pimples are alike — if you’ve had your share, you know this. Some, such as open comedones, better known as blackheads, are painless and mainly just an aesthetic concern. 

Others, such as pustules, nodules, and cysts can be large, painful, and lead to acne scars, according to Johns Hopkins.

Pustules, for example, are topped with pus and are typically red around their base. Nodules are hard, large and painful, and come from deep beneath the surface of the skin. Cysts are deep, painful pimples that are filled with pus.

What Qualifies as “Severe” Acne? 

We’ve all struggled with pimples at some point. (If you haven’t, the rest of the world hates you). But what makes your acne “severe?" 

One rating scale for acne, the Adult Female Acne Scoring Tool, rates severe acne as acne covering the entire face with several types of pimples, and rare nodules (as defined by a guide in the Official Publication of the Brazilian Society of Dermatology.) 

Very severe acne, also known as cystic acne, according to this scale, is very inflammatory acne, including deep and painful nodules and papules. 

According to an article published by the Institute for Quality and Efficiency in Health Care, severe acne is most likely to lead to scarring, so isn’t only concerning while you’re struggling with pimples now, but long into the future.

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Severe Acne Causes 

At a foundational level, acne is caused by androgens or male sex hormones. This is why acne peaks in adolescence and why it’s common among women with polycystic ovarian syndrome (PCOS).

But several factors may increase your risks of suffering from acne, particularly into adulthood. 

  • Certain medications. Medications such as benzodiazepines, lithium,  cyclosporin, serotonin uptake inhibitors, progestin birth control, and vitamin B complexes may be associated with acne development.

  • Smoking. Tobacco use has a strong connection to acne in adult women. It even has a name: “smoker’s face,” and is characterized by comedones and some inflammatory pimples.

  • Hormone (endocrine) conditions. Certain hormonal imbalances or conditions can increase your risk of acne, particularly those that result in excess androgens. These may include PCOS and tumors on the ovaries, adrenal glands, and pituitary gland.

  • Menstrual cycle. In addition to androgens, acne can be triggered by fluctuating hormones in the menstrual cycle. Acne generally worsens in women around their period, but also during perimenopause, pregnancy, and menopause.

  • Stress. Stress and lack of sleep are known risk factors for acne, and this risk factor is one of few within your control.

  • Genetics. According to the American Academy of Dermatology, if someone in your family has severe acne, there’s a greater chance you will, too.

Treatment for Severe Acne 

One of the primary considerations your healthcare provider or dermatologist will have in treating your acne is how severe it is. 

Someone who gets a few pimples each month will not be given the same treatment regimen as someone with severe, ongoing acne troubles. 

  • Topical treatments. Topical acne treatments are generally the first-line defense against acne. Your healthcare provider may recommend over-the-counter, non-comedogenic solutions like benzoyl peroxide, prescription medications in the form of lotion (like an acne cream), like the retinoid, tretinoin, or a chemical peel. However, these are generally not enough for severe acne. They’re most often used in conjunction with oral medications. 

  • Oral acne medications. Systemic treatments, that treat your acne from the inside-out, are often prescribed for severe forms of acne cases. They can include any number of prescription solutions, such as isotretinoin, 

  • Antibiotics. Topical and oral antibiotics such as clindamycin, tetracyclines, erythromycin, and doxycycline work to control the acne bacteria that causes your lesions. Antibiotic resistance is a concern with these, so they generally are not used long-term. 

  • Oral contraceptives. Many women have success treating their severe acne with birth control pills. Oral contraceptives help regulate hormonal changes that can lead to breakouts.

  • Androgen-blockers. If excess androgens are the suspected cause of your acne — as in the case of PCOS — your healthcare provider may recommend an androgen blocker such as spironolactone.

Physical treatments. Visiting a dermatologist to undergo hands-on treatment is another option. If you’ve ever seen pimple-popping videos on the internet (Ew!), this is one of the physical treatments we’re referring to. Others include acne extraction and injections of corticosteroids into acne nodules and cysts.  But in addition to removing acne lesions, a dermatologist may recommend phototherapy.

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Severe Acne: A Final Thought

If you find yourself with low self-esteem from your acne struggles, it's time to seek medical advice from your healthcare professional. 

Start a free consultation with a hers skincare professional now to start your journey to clearer skin.

6 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Adult acne. American Academy of Dermatology. (n.d.). Retrieved September 22, 2021, from https://www.aad.org/public/diseases/acne/really-acne/adult-acne.
  2. Auffret, et al. (n.d.). AFAST - adult Female acne Scoring Tool: An easy-to-use tool for scoring acne in adult females. Journal of the European Academy of Dermatology and Venereology : JEADV. Retrieved September 22, 2021, from https://pubmed.ncbi.nlm.nih.gov/26642798/.
  3. Bagatin, et al. (2019). Adult female acne: A guide to clinical practice. Anais brasileiros de dermatologia. Retrieved September 22, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360964/.
  4. Rathi, S. K. (2011, January). Acne vulgaris treatment : The current scenario. Indian journal of dermatology. Retrieved September 22, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088940/.
  5. Russell, J. J. (2000, January 15). Topical therapy for acne. American Family Physician. Retrieved September 22, 2021, from https://www.aafp.org/afp/2000/0115/p357.html.
  6. U.S. National Library of Medicine. (2019, September 26). Acne: Overview. InformedHealth.org Internet. Retrieved September 22, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK279211/.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.