Acne varies greatly in severity. Most cases are mild to moderate. However, some people suffer from very severe acne, also known as cystic acne. Over-the-counter products may effectively treat more mild cases of acne, but severe or cystic acne may require treatment by a dermatologist.
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Inflammatory or fluid-filled acne blemishes all begin the same way: with clogged pores. Bacteria trapped inside the clogged pore begins to multiply, causing a break in the follicle, or pore, wall. The depth of this break and amount of infection determine the type of blemish. Papules occur close to the surface of the skin, and are usually quite small and red. Sometimes a whitehead forms that creates a pustule, which is the garden-variety pimple. Nodules form when the break happens deep in the skin. The infection spreads to surrounding pores. This results in a large, red lump that's firm to the touch. Finally, cysts form when the break occurs deep in the skin as well, but a membrane forms around the infection. This causes a large, red lump that is soft to the touch.
Smaller blemishes typically heal with little scarring and may leave superficial pigment marks on the skin. These often fade within a few weeks to a few months. However, severe blemishes such as nodules and cysts can cause permanent scarring, resulting in permanent indents in the skin. Additionally, the Online Dermatology Journal says acne also affects psychological health. Sufferers may suffer from depression, social phobias or anxiety as a direct result. Prompt treatment is essential to prevent permanent physical scarring as well as psychological damage.
Fluid-filled nodules and cysts may respond to topical treatment. Prescription creams called retinoids are often prescribed for more severe cases of acne. Retinoids are derived from vitamin A, and have been proven effective in topical and oral forms for treating varied severities of acne. Retinoids unclog pores and prevent pores from clogging. They replace old skin with new skin and slow skin cell sloughing, which prevents dead skin cells from building up and clogging pores. Additionally, retinoids have a lightening effect on the skin, which may help reduce the appearance of red spots left over from healed breakouts. The most common side effects include severe skin dryness, redness, stinging or peeling, as well as increased sun sensitivity.
Severe or cystic acne often requires more advanced treatment for scar prevention. Systemic treatment with oral medications may be combined with topical medications or used alone. The most effective oral medication for acne is isotretinoin. Isotretinoin is a retinoid, like the topical medications, that's taken in the form of a pill. A single course of treatment lasts about four to five months and consists of taking one to two pills daily. Isotretinoin focuses on oil reduction, fighting bacteria, reducing inflammation and unclogging pores. Possible side effects are numerous and include depression, chest pain, trouble swallowing, dry skin, dry mucous membranes and bone pain. Patients much be followed closely by a dermatologist to avoid serious side effects and complications. Women are required to take a monthly pregnancy test and use two reliable forms of birth control to prevent pregnancy. Isotretinoin can cause very serious birth defects when used at any time during pregnancy.
Acne sufferers often tend to take a wait-and-see approach before seeking professional treatment for acne. Although mild or moderate acne may cause limited scarring, cystic or nodular acne can cause permanent and disfiguring scars. According to the American Academy of Dermatology’s AcneNet, treatment for acne scarring involves filling the scars with collagen, surgical removal of the scars and laser resurfacing. Seeking prompt treatment for the acne itself is much less invasive than treating the scarring that results from postponing treatment.