The Best Treatment for Severe Acne
Grade 3 Pustular Acne Best Treatment Tips
The best treatment for severe acne or grade 3 pustular acne is a combination of topical and systemic medications. Dermatologist Dr.Hanish Babu provides expert advice on best treatment for severe acne.
| Clinical Picture of Severe Acne - In this type of acne, there are more inflamed pustules.
- A few inflamed papules may also be seen.
- The lesions are tender and reddish.
- Pustules, if not treated properly, heal with scars.
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Tips on the Best Treatment for Severe Acne -
Treatment is initiated with oral antibiotics (Tetracycline or Doxycycline) in full dosage till new lesions stop appearing. The duration of treatment is usually 4-8 weeks. -
Gradual tapering of the dosage is done every month depending upon the response to treatment. -
Topical therapy is started as for the moderate group: Morning topical Clindamycin or Erythromycin solution. Evening Benzoyl Peroxide 5% gel applied overnight. -
Topical Tretinoin is substituted for Benzoyl Peroxide after the pustular lesions subside. -
In unresponsive males, Systemic Isotretinoin is considered after 3 months of systemic antibiotics. -
Female patients in the child bearing age group are treated with antibiotics for longer period (upto 6 months) before considering isotretinoin. See special precautions on Isoretinoin. -
All these medications should be taken under the guidance of a dermatologist only. This is only for information, and does not replace personal consultation! (See disclaimer).
Practical Points on the Best Treatment for Severe Acne -
All the above medications should be taken under the guidance of a dermatologist only. The information given here is only for educational purpose and cannot replace personal consultation with your acne physician! (See disclaimer). -
Benzoyl peroxide (BP) and Topical Tretinoin may cause irritation due to excessive peeling in individuals with sensitive skin. The following steps are advised to minimize this adverse effect: -
Apply BP and tretinoin only at night -
Use a water based sun screen during daytime -
In the first week, apply the BP/Tretinoin gel/cream for 2 hours and wash off with water. If the skin is tolerating the application well, overnight application can be started from the second week onwards. -
If the patient complains of sensitive skin, start off with 2.5% gel, then shift to 5% gel after about 2-3 weeks (for Benzoyl Peroxide) and 0.025% and 0.05% respectively for Tretinoin. -
Sometimes Benzoyl Peroxide and Topical retinoids can cause flare up of acne lesions. This is a good sign rather than the other way round. Do not stop application in such cases. The flare up will subside gradually and the skin lesions will start clearing soon. -
A brownish pigment is seen after treatment with BP when the papules and pustules subside. This will gradually subside. Continue using a sunscreen during this phase. -
For small post acne scars, continue using night application of topical retinoids at a strength of 0.05%. -
Also see the acne best treatment principles and acne best treatment general advices to supplement the tips for severe acne best treatment given on this page.
FAQ on Severe Acne: How long should I continue treatment for severe acne?
Answer: This differs from individual to individual. Some severe acne sufferers can start reducing their applications and/or systemic antibiotics after a period of 12-16 weeks, while others may have to continue for longer periods. I advice my patients to continue the treatment till new lesions stop appearing, then taper and gradually stop the systemic treatment. The morning antibiotic solutions (Clindamycin or Erythromycin) are continued further even after stoppage of the systemic therapy. Stopping both together is an invitation for recurrence! Benzoyl peroxide is used in a reduced strength. If after 3-4 weeks, new lesions are still not appearing, you can reduce the frequency of application of BP as well. Later you may substitute the Benzoyl Peroxide with topical tretinoin.
Remember though, you may have to restart the regimen if there is recurrence at any later period.
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