Stacks Image 2123

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)