Severe Acne: A Problem With Mysterious Causes

When bad acne inflames and scars your skin and also affects your self esteem, you need professional treatment. Four main types of severe acne can cause chronic breakouts. Unfortunately while there are a number of good treatments for severe acne, the causes remain somewhat of a mystery.

What Is Severe Acne?

The pimple that pops up every so often - no matter how big and red it is, or how terrible the timing may be - isn't considered severe acne. Even a monthly acne breakout with a few bumps here and there that disappear isn't typically serious enough to need the extensive treatment that acne requires.

Severe acne is diagnosed when extremely red, inflamed, and deep acne lesions called cysts occur to the extent that they actually disfigure the skin. This level of acne causes significant scarring and permanently damages the skin.

A dermatologist can help treat acne, typically with an oral medication. Acne scars may need treatment as well, often with a procedure like microdermabrasion to remove the damaged layers of skin.

The Four Main Types of Severe Acne

There are other types, but these are the most common:

Nodulocystic acne. The distinguishing feature of nodulocystic acne is inflamed cysts, which are bumps filled with pus, fluid, or some other material. These painful cysts can be large - a few centimeters in size - and are most often found on the:

1. Shoulders
2. Back
3. Chest
4. Neck
5. Face

One cyst may occur independently, or you may have large groups of cysts clustered together. Nodulocystic acne is difficult to treat, but treatment options include:

Acne surgery - drainage and excision of the cysts
Antibiotics
Corticosteroid injections into the cyst

Acne conglobata - Acne conglobata is a type of severe chronic acne - meaning it's an issue that you always have to deal with and can never truly cure, although you can manage symptoms with treatment. It strikes men more often than women, usually between the ages of 18 and 30.

The first sign of acne conglobata may be pimples that get worse instead of better, eventually forming inflamed, infected nodules. These nodules are filled with pus and may have a foul odor. Acne conglobata may occur in people who used to have acne that has been managed well for years, but suddenly returns.

The most common symptoms of acne conglobata are:

Deeply inflamed abscesses in the skin
Blackheads that are typically found on the buttocks, torso, upper arm area, neck, and face
Deep scars
Significant damage to the skin
Red, inflamed bumps often develop surrounding blackheads or whiteheads, get larger, and finally start to seep pus. Ulcers may develop beneath these bumps, causing scarring and crusting over.

Acne conglobata is most often treated with isotretinoin, sometimes in addition to antibiotics. It's important to continue working with a dermatologist to treat and prevent any recurrent episodes of this type of severe acne.

Acne fulminans. This type of acne is characterized by sudden and severe inflammation that affects the entire body. Its symptoms include:

Fever

Joint pain and inflammation, most often in the knees and hips

Severe acne with ulcers

Acne fulminans often develops following acne conglobata, when treatment has been attempted but failed. Treatment focuses on managing the inflammation, so non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed. Corticosteroid drugs may also be needed to help control inflammation. This recurrent type of acne should be monitored and treated over the long-term by a dermatologist, and may need treatment with the systemic medication isotretinoin.

Gram negative folliculitis. Gram negative folliculitis is a type of infection that looks like bad acne. It occurs when follicles in the skin become inflamed from a bacterial infection. It can sometimes develop in people who are trying to treat another form of severe acne with topical or oral antibiotics over a long period of time.

A Gram stain is used to detect certain bacteria; those that do not turn blue when introduced to the Gram stain are known as "Gram negative."

Gram negative folliculitis can be difficult to treat, because the bacteria don't respond to many antibiotics used to treat severe acne. However, isotretinoin and certain antibiotics (often ampicillin and Proloprim, or trimethoprim) can successfully treat Gram negative folliculitis.

Without treatment, these four types of acne can cause significant scarring and damage to the skin, as well as emotional problems and low self-esteem. All types of severe acne should be diagnosed and treated by a dermatologist, and many of them can be successfully managed.

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