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In this segment, I will talk about the treatment of severe or cystic acne,
and I will give you a broad overview of the different modalities that I
will discuss at a later segment in more detail.
Severe or cystic acne, as the name already implies, is mostly made up of
cystic lesions inside the skin, inflammatory papules, pustules, sometimes
the are confluent and form abscesses. It is very, very important to turn
off this inflammation as quickly as possible in order to avoid terrible
scarring on the skin.
The treatment options for severe cystic acne are: Isotretinoin, better
known as Accutane; photodynamic therapy; oral antibiotics given for a short
period of time and matched with a topical regiment that can further subdue
and then also maintain reduced acne; and in women, there's a possibility of
treatment with an agent known as spironolactone, which is not FDA-approved
for the treatment of acne, but rather for the treatment of high blood
pressure, but has for a number of decades now been used for the treatment
of severe cystic acne.
Just to be complete, I would like to mention that sometimes oral
contraceptive pills in women can reduce acne as well and may show you this
type of improvement when you're already taking these medicines. In my
practice, I do not start treatment with oral contraceptive treatment,
because there are many other choices that I can resort to.
In addition to these medicines and/or more dramatic treatments that I've
just mentioned, ancillary treatments are also used to tame the acne, such
as red light treatments, pulsed dye laser treatments, and smooth beam
treatments.
All of those treatment modalities, with the exception of Accutane, are
oftentimes used in concert and not by themselves in order to really subdue
the process.