Severe acne

Cysts, nodules, pain... Severe acne, whether nodular acne, severe cystic acne or even acne fulminans, is often experienced as a real struggle.

So, you're wondering why some people develop these types of acne? What are the differences between "classic" acne and these severe forms of acne that sometimes leave permanent scars? And what are the solutions for relieving severe acne?

In this article, discover everything you need to know about severe acne and practical advice on how to deal with it.

How is severe acne defined?

Severe acne is a type of acne that manifests itself as significant lesions, often spread across the entire face.

The types of lesions visible in severe acne are⁽¹⁾:

• retentional acne lesions, with blackheads (open comedones) and whiteheads (closed comedones).
• inflammatory lesions (papules, pustules, cysts and nodules) that cause pain and redness.

Other areas of the body, such as the back, are frequently affected, accentuating the physical and psychological impact of this form of acne.

Who is affected by severe acne?

Among people with acne, approximately 12% develop a severe form of acne⁽¹⁾, mainly adolescents with juvenile acne, but also adults.

Severe acne seems to affect boys more than girls. A family history of acne is often found, suggesting a significant genetic factor.

What causes severe acne?

Severe acne is influenced by several interacting factors:

• Male hormones, called androgens, stimulate sebum production, especially during adolescence. This excess sebum can clog pores and create an ideal environment for inflammation.
• Stress also plays a role: cortisol, released in the body during times of stress, also affects sebum production, which can make things worse.
• Genetic predisposition: if your parents had severe acne, you are likely to be affected too.
• The microbiome: the skin naturally harbours a bacterium called Cutibacterium acnes. When pores are blocked, this bacterium proliferates and triggers inflammation. But be careful, it is not only the presence of this bacterium that causes acne: it is also linked to an imbalance of bacteria present in the skin microbiome.
• Environment and lifestyle can also have a negative impact on skin quality.

Scars that are sometimes irreversible

Deep lesions such as nodules or cysts, typical of severe acne, can leave visible marks for life: indented or thickened scars, or pigment spots.
This is why it is strongly advised not to "pick at" your spots. The priority is to start medical treatment with a professional and appropriate follow-up.

As for extracting severe acne spots, this should always be done by a dermatologist or qualified professional in order to minimise scarring.

A major psychological impact

Severe acne can profoundly affect mental wellbeing:

• The fear of other people's looks and comments.
• Lower self-esteem and a lack of self-confidence.
• Withdrawal into oneself, which can lead to isolation.
• A risk of depression.
• An impact on academic or professional success.

Comprehensive treatment of severe acne is essential: caring for the skin, but also providing quality support and listening.

Restrictive treatments for severe acne

Severe forms of acne often require prolonged treatment, sometimes with side effects.

Any treatment for severe acne requires rigorous medical supervision and perseverance.

An impact on quality of life

To measure the extent to which acne can affect quality of life, doctors have tools at their disposal⁽²⁾, such as:

• CADI (Cardiff Acne Disability Index): this is a quick 5-question questionnaire that assesses the emotional and social impact of the acne.
• DLQI (Dermatology Life Quality Index): here, 10 aspects of life are assessed, such as leisure activities, work and social relationships.

What treatments are available for severe acne?

As a first step, the dermatologist may prescribe an oral antibiotic, often combined with topical treatments (applied locally).

For the most severe or resistant forms, the dermatologist will prescribe oral isotretinoin⁽³⁾. This treatment for severe acne has a comprehensive effect on acne but tends to irritate and dry out the skin. Compensatory care is therefore recommended to limit these effects.

Currently, new advances in acne treatment⁽⁴⁾ make it possible to combine several active ingredients in a single formula. The benefit? It’s twofold! Acting on multiple levels while simplifying application and improving tolerance.

Prevention strategies: how can we promote the prevention of severe acne?

To prevent severe acne, adopt a good skincare routine, use products that are suitable for your skin type and have been dermatologically tested, watch your diet and consult a professional promptly if necessary.