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Bad Acne: How to Treat Really Bad Acne

Katelyn Hagerty

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 5/04/2021

Whether acne stole the show in your yearbook photo or is now a persistent pimply presence in adulthood — this skin condition can be a pain to deal with at every age and point in time.

However, while a break out of pimples, whiteheads, and blackheads is reason enough to raid the local cosmetics supply store, more severe forms of acne exist. 

Cysts and nodules aren't just an unwelcome addition to the skin, they are also painful forms of acne that can cause scarring. This form of acne requires proper treatment methods to get it under control.

We'll be checking out the ways to manage really bad acne. We'll also be taking a pop at the types and causes of severe acne.

Types of Severe Acne

When acne gets bad, it can get really bad. Severe forms of acne don't just pop up on the face and along the jawline, they can also spread to the neck. 

If that isn't bad enough, these breakouts can ruin many a plan to rock a V-neck tee, or a low-back top, seeing as they are known to appear on the chest and back.

Typically, acne is formed when hair follicles under the skin become clogged with bacteria, oil, and dead skin cells. Really bad acne is formed just about the same way. 


This form of acne is formed when the opening to a sebaceous gland (a gland responsible for producing sebum/oil in the body) becomes clogged. You’ll recognize it as a small lump on the skin surface, although it can get slightly bigger in size. 

When the sebaceous gland becomes blocked, oil production continues, but there is no escape to the surface of the skin. This form of acne penetrates deep into the skin.


Nodules are lesions that penetrate deep into the skin. Like cysts, they form when the pore fills with enough bacteria, oil, and dead skin cells. This leads to inflammation that bores deep into the skin surface. However, unlike cysts which are filled with pus and tender to the touch, nodules are pus-free and can feel harder to the touch.

Causes of Acne

Even though nobody wants it around, acne may show up for a number of reasons. Some of the causes of this skin condition include:

  • Menstrual cycle

  • Genetics

  • Medication

  • Stress

  • Smoking

  • Endocrine diseases

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How to treat really bad acne

If you've ever had to deal with severe acne, then you probably know its effects aren't simply skin deep. Cysts and nodules can also affect your mood, and how well you view yourself. It also doesn't help that bad acne tends to be a stubborn cookie to crack.

Notwithstanding, there are proven ways to treat and manage severe forms of acne. These include:


This medication may be the holy grail for treating UTIs and strep throat, but it is also a useful way to manage bad acne.

Antibiotics primarily kick bacteria butt. This means they are able to fight off  P. acnes, acne-causing bacteria in the body. They also have anti-inflammatory properties and are able to clear off the swelling and redness that comes with acne.

Antibiotics are usually the first recommendation you'll receive to properly manage severe acne.


Four thing comes together to cause acne: bacteria, clogged pores, excess oil, and inflammation — isotretinoin, a super retinoid, just so happens to be able to attack them all.

This treatment is able to reduce the production of oil and lower the presence of acne-causing bacteria. Isotretinoin is also able to prevent the formation of comedones, and has notable anti-inflammatory effects.

If you're really looking to hit acne where it hurts, this retinoid is a good option. However,  you'll want to look out for side-effects like dermatitis, hair loss, itching, and fragile skin when using this treatment. It has also been linked to birth defects following use during pregnancy, and may be a cause of mood disorders like depression.

Birth control

A pill a day isn't just good for keeping the baby away, oral contraceptives are also very handy for helping to manage bad acne.

This is thanks to the actions of estrogen — a hormone you can thank for helping to develop and maintain your reproductive system. 

This hormone helps to prevent the formation of androgens like testosterone is a hormone that can encourage acne to appear by promoting the production of oil.

Birth control is effective at treating mild forms of acne like blackheads and whiteheads. This medication is just as tough on more severe forms like cysts and nodules.

So far, the FDA has approved four oral contraceptives for the management of acne. They include Ortho Tri-Cyclen, Estrostep, Yaz and Beyaz.


This is another form of hormonal therapy noted for its anti-acne properties. Spironolactone is popularly used for managing high blood pressure and for the removal of excess water.

To bring you closer to achieving acne-free skin, this medication has similar anti-androgen effects and is able to manage the production of androgens which encourage breakouts in the body.

Spironolactone may be used alone, especially in women above the age of 35. However, it is more commonly prescribed with the pill.

If spironolactone is recommended for treating your acne, you should know that long term use has been known to cause irregular periods, frequent bathroom breaks, dizziness, headaches, nausea, breast tenderness and enlargement.

Acne removal

In certain cases where acne gets really bad, the best thing to do is to roll up your sleeves and dial a dermatologist to help get it out.

To avoid infections, it's recommended that dermatologists physically remove painful cysts and nodules where other acne treatments have fallen short.

This may require injecting the cyst or nodule with a corticosteroid to reduce the pain and size. Likewise, an incision may be made in the cyst and nodule, following which it will be drained to help with managing its effects.

Where one or more of these treatments are effective in managing your acne, your skin will require continued TLC to keep breakouts away. 

This may require observing skincare practices like twice-daily washes, using gentle cleansers, ensuring skincare products are non-irritating, rinsing the skin with lukewarm water, as well as steering clear of popping or squeezing breakouts.

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One Last Thing

Dealing with really bad acne can be rough. Not only do cysts and nodules are the most severe forms of acne, complete with pain and annoyingly high chances of scarring.

However despite how serious this condition can get, there are tried and trusted ways to get it under control. However, before deciding on birth control, antibiotics, retinoids or other treatments, it's always a good idea to first hear what the dermatologist thinks.

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.