Severe acne is characterized by deep cysts, inflammation, extensive damage to the skin and scarring. It requires an aggressive treatment regimen.
Treatment for severe acne requires oral treatment. Patients should be under the care of a dermatologist.
Many patients will be treated with oral isotretinoin.
If this is not suitable, the following may be used:
High dose oral antibiotics for six months or longer
In females, especially those with polycystic ovary syndrome, oral antiandrogens such as oestrogen/cyproterone or spironolactone may be suitable long term. Systemic corticosteroids are sometimes used for their antiandrogenic effect. Flutamide and finasteride also been reported to be of benefit in hyperandrogenic women. At this time, these medicines are registered for treatment of prostatic cancer (and in the case of finasteride, for androgenetic alopecia) in males only, in New Zealand.
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