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Treatment for Severe Nodular or Cystic Acne

People with nodules or cysts should be treated by a dermatologist (doctors who specialize in skin problems). Scarring can be prevented with appropriate treatments. Your dermatologist can prescribe oral antibiotics and oral contraceptives. Large inflamed cysts can be treated with an injection of a drug that lessens the redness, swelling, and irritation, and promotes healing. Effective treatments are available for this type of acne.


For people with severe inflammatory acne, your dermatologist may prescribe Isotretinoin - Accutane, a retinoid (vitamin A derivative), if other treatments have not worked. This is a strong medicine that can help prevent scarring and treat active disease. But, Accutane also can cause birth defects. You and your dermatologist can decide whether this medicine is right for you based on the pros and cons listed below.

Some large cysts do not respond to medication and may need to be drained or removed. Your dermatologist is the only person who should drain or remove these. You should never try to drain or remove your acne by squeezing or picking. This can lead to infection, worsen your acne, and cause scarring. If you don't see a change in your skin in six to eight weeks, talk with your doctor about your treatment plan.

Isotretinoin (active ingredients)
Accutane (brand name) - a retinoid (vitamin A derivative).

Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Advantages of Isotretinoin (Accutane)
Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most people. In people where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

  • Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.
  • Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medicines like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin - however - the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it's important to consult your doctor.
  • Other possible side effects of isotretinoin include:
    • Dry eyes, mouth, lips, nose, or skin (very common)
    • Itching
    • Nose bleeds
    • Muscle aches
    • Sensitivity to the sun
    • Poor night vision
    • Changes in the blood, such as an increase in fats in the blood (triglycerides and cholesterol)
    • Change in liver function

To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

Other Treatments for Acne
Doctors may use other types of procedures in addition to drug therapy to treat people with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may suggest a medical or surgical procedure to help reduce the scars. A superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes used. Another treatment option for deep scars caused by cystic acne is the transfer of fat from another part of the body to the scar. A doctor may also inject a synthetic filling material under the scar to improve its appearance.


References:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
www.niams.nih.gov/
U.S. Department of Health and Human Services
www.4woman.gov/
January 2005 - 2006

This summary does not include everything there is to know about the medicine mentioned above. Do not use this medicine without first talking to your doctor. Other brand names or generic forms of this medicine may also be available. Side effects other than those listed above may occur. This medicine may be prescribed for other uses. If you have questions or concerns, or want more information, your doctor or pharmacist has the complete prescribing information about this medicine and possible drug interactions.