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Severe (Cystic) Acne

Patients with severe (cystic) acne generally have many inflammatory pimples and at least a few deeper-seated cystic nodules. The chest and back may be involved as well. There may be pink or red marks present called post-inflammatory erythema after pimples have resolved. As some of the inflammatory pimples heal, there can be scars. The treatment regimen below can help many patients, but if no improvement is seen after 8 weeks, you should consult with a dermatologist regarding isotretinoin.

Main Treatments - Face

• Use adapalene gel or other retinoid at night on the entire face
• Use benzoyl peroxide leave-on gel in the morning on the entire face
• Use anti-acne cleansers when washing the face
• If very oily, use anti-acne toner
• Take oral zinc supplements for 2-3 months
• Take fish oil supplements on an ongoing basis

Main Treatments - Chest, Shoulders, or Back

• Use benzoyl peroxide leave-on gel in the morning on the entire zone
• Use anti-acne cleansers when washing the zone in the shower
• If very oily, apply anti-acne toner
• Take oral zinc supplements for 2-3 months
• Take fish oil supplements on an ongoing basis

Skin Care

Add ons

• For new zits, use pimple spot treatment
• For flat red or pink blemishes, use a blemish spot treatment
• For any raised scars, use scar spot treatment

For Women Only

• If you use hormonal contraception, make sure it’s acne-friendly birth control
• If you are pregnant or attempting conception, your treatment options are more limited. Visit our page on acne during pregnancy
• Breastfeeding patients may safely use all the treatments recommended on this page except isotretinoin (rx only)