Acne is the most common skin condition seen in the United States, with more than 40 million Americans estimated as currently having issues with acne, according to the American Academy of Dermatology. However, the severity of acne can vary widely, with some individuals only experiencing mild comedones and others developing more serious cases of inflammatory acne. In some cases, the inflammation associated with more severe cases can develop abscesses on the skin, which can cause permanent damage to the tissue if not treated before the abscess ruptures.
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Severe acne that can result in an abscess starts with a mild form of acne called a comedone, more commonly referred to as blackheads or whiteheads. A comedone forms when natural sebum oil from your sebacious glands mixes with dead skin cells to form a small plug in the pores. When the plug forms toward the surface, it's exposed to oxygen and turns black, hence the name blackhead. When the comedone forms deeper in the pore no oxygen is present, so the comedone looks more like a white spot on the skin.
Acne plugs create the perfect environment for bacteria to thrive. One bacteria in particular, known as Propionibacterium acnes, or P. acnes, especially thrives beneath an acne plug. As the bacteria multiplies an infection occurs, resulting in an immune response by your body. This response causes inflammation to develop in the affected comedone, leading to inflammatory acne like papules or pustules, more commonly known as pimples.
An abscess occurs when swelling develops within the tissue of your skin, which results in the accumulation of pus. As the P. acnes infection grows in severity inside the affected pore, the immune system continues to direct white blood cells to the area to fight off the bacteria. The white blood cells move through the walls of the blood vessels and fill up the area beneath the skin affected by the acne. In severe cases, this can lead to acne nodules or cysts, which contain pus. Pus is an accumulation of dead and living white blood cells, as well as bacteria, dead tissues and other substances. If left untreated, inflammation can cause damage to the skin tissue, resulting in acne scarring once the abscess has healed.
Acne that results in abscess formation is typically serious. As such, it's important to work with your doctor to find the right treatment method for your individual case. Your doctor may recommend a wide variety of treatments including prescription medications like antibiotics or isotretinoin to help kill off the P. acnes bacteria and heal the infection. Corticosteroids may be injected into the abscess to reduce inflammation and prevent an acne cyst or nodule from rupturing. Drainage and surgical excision may also be necessary in severe cases to drain out pus from the abscess.