Skin Health Acne Treatment How to Treat Severe Acne By Angela Palmer facebook Angela Palmer is a licensed esthetician specializing in acne treatment. Learn about our editorial process Angela Palmer Medically reviewed by Medically reviewed by Casey Gallagher, MD on November 25, 2019 Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado. His research has been published in the New England Journal of Medicine. Learn about our Medical Review Board Casey Gallagher, MD Updated on September 17, 2020 Print Acne of any type can be upsetting, but severe acne is particularly distressing. Severe acne (sometimes called cystic acne) is inflamed, often painful, and can happen on both the face and the body. Hiraman / Getty Images It's particularly important to start treatment soon because severe forms of acne can often cause scarring. Another annoyance: this type of acne can be tough to treat. But, with the right medications and some perseverance, you can see a huge improvement in your acne. How to Tell If You Have Severe Acne Skip the Over-the-Counter Acne Products The first thing to do is to get rid of those over-the-counter acne products. They just won't work for severe acne. Save yourself a bunch of frustration, and don't waste your time on them. Severe acne must be treated by a medical professional. You'll need prescription acne medications to really get your severe acne under control. This means a trip to the dermatologist. It may seem like a lot of extra time and added expense, but once you start seeing actual improvement, you'll be so glad you made that appointment. 5 Signs You Need a Prescription Acne Treatment Prescription Topical Medications Are a Better Choice The first line of defense against acne will most likely be a topical medication. You might even be prescribed more than one. There are plenty of options, and each group of medications works in a different way. Topical Retinoids These are a mainstay of acne treatment. Topical retinoids help keep pores unclogged, so they're good at treating blackheads and inflamed breakouts. They have other benefits, too. Topical retinoids can make large pores appear smaller, and are also used as anti-aging treatments. How Effective Are Retinoids in Treating Acne? Topical Antibiotics Antibiotics kill bacteria. Acne is, in part, caused by bacteria so antibiotics are often prescribed to help get acne under control. Topical antibiotics are applied to the skin, rather than taken by mouth. Bacterial resistance to antibiotics is becoming a problem, so there is some worry that these aren't as effective as they used to be. To combat this, you'll most likely be prescribed a second topical acne medication to use along with topical antibiotics. Combination Medications Acne improves more quickly when it's attacked on several fronts. To accomplish this, dermatologists have long prescribed multiple medications. Some newer acne treatments take this idea one step further by blending two acne-fighting ingredients into one medication (like benzoyl peroxide and adapalene, or tretinoin and clindamycin). The main benefit of these treatments is they're easy to use, just one application and you're done. The drawback is that combination treatments can be pricier than other medications. Are Combination Medications the Right Acne Treatments for You? You May Need Oral Acne Medications Depending on the severity of your acne, and how it responds to topical treatment, your dermatologist will likely prescribe oral medications to help get your breakouts under control. Of course, we're all familiar with the acne medication isotretinoin (Accutane), but there are many more options. Oral Antibiotics Just like topical antibiotics, oral antibiotics reduce the amount of acne-causing bacteria on the skin. These are typically prescribed along with a topical acne treatment, and ideally, are used for only a short period of time. Antibiotic-resistant bacteria are a growing problem, so it's especially important that you use your oral antibiotics exactly as directed. Spironolactone Spironolactone helps to calm the hormones that cause acne to develop. Once a young woman has a menstrual cycle, if the acne flares peri-menstrually, spironolactone may be considered an appropriate treatment. This is one medication that needs to be used long term to be effective, though. The Hormonal Acne Treatment You've Never Heard About Oral Contraceptives Oral contraceptives, or birth control pills, are another treatment option for ladies at least. Just like spironolactone, birth control pills help regulate hormone fluctuations that can trigger acne breakouts. They can be used by teenage girls and adult women alike. Isotretinoin And, of course, there is isotretinoin (better known by the brand name Accutane). This is a powerful medication that isn't the perfect choice for every person. But in the right cases, isotretinoin can clear up acne that hasn't responded to anything else. Isotretinoin is only prescribed for short periods of time, and it generally wipes out acne for good. A Beginner's Guide to Treating Acne with Isotretinoin A Word From Verywell Even if you've tried to clear your acne before without much success, don’t give up on treatment yet and don't give up hope. You might need a new medication, a renewed commitment to following through with your treatment plan, or even a new dermatologist. There is no reason to continue to suffer with severe acne. There is a treatment out there that is right for you. Was this page helpful? Thanks for your feedback! Dealing with acne can be frustrating. Our free guide provides expert tips to help you take control. Sign up and get yours today. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Fabbrocini G, Annunziata MC, D'Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080. doi:10.1155/2010/893080 Leyden J, Stein-gold L, Weiss J. Why topical retinoids are mainstay of therapy for acne. Dermatol Ther (Heidelb). 2017;7(3):293-304. doi:10.1007/s13555-017-0185-2 Kraft J, Freiman A. Management of acne. CMAJ. 2011;183(7):E430–E435. doi:10.1503/cmaj.090374 Additional Reading Zaenglein AL, Pathy AL, Schlosser BJ, et. al. Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology. 2016; 74(5): 945-73. Zouboulis CC, Bettoli V. Management of Severe Acne. The British Journal of Dermatology. 2015 Jul;172 Suppl 1:27-36.