How to Treat Severe Acne

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.

Woman looking at her skin in the mirror
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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.

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.

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.

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.

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 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.

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.


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 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.

3 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.
  1. Fabbrocini G, Annunziata MC, D'Arco V, et al. Acne scars: pathogenesis, classification and treatmentDermatol Res Pract. 2010;2010:893080. doi:10.1155/2010/893080

  2. 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

  3. Kraft J, Freiman A. Management of acneCMAJ. 2011;183(7):E430–E435. doi:10.1503/cmaj.090374

Additional Reading

By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.