If you have acne, you’re not alone. According to the American Academy of Dermatology, about 85 percent of people between the ages of 12 and 24 experience acne outbreaks. In fact, acne can happen at any age.

Severe acne is more than a few minor blemishes that clear up in a matter of days. People with severe acne typically have large cysts or inflamed nodules that cover a large area of skin. Severe acne can also cause swelling, scarring, and hard, painful lesions.

Severe acne can be frustrating to deal with. You may be tempted to try some things that only make matters worse.

While it may take time to find what works for you, there are several effective treatments for severe acne. The right strategies can bring relief during outbreaks and prevent infection, discoloration, or scarring.

Continue reading to learn what to do — and what not to do — when you have severe acne.

It’s important to follow a skin care routine. Gentle cleaning is key to protecting your skin’s health. Consider these tips:

  • Wash your face twice a day.
  • Use mild soap and warm water or a gentle cleanser.
  • Be very careful when shaving your face.
  • Wash your face again after sweating, as perspiration can make acne worse.
  • Take a full shower after strenuous physical activity to remove excess oil and sweat.
  • Remove makeup before bed.

Washing your face too many times a day can make the acne worse. Wash morning and night with either a gentle soap such as CeraVe or a mild over-the-counter acne wash such as benzoyl peroxide or salicylic acid.

Also, do not use any abrasive scrubs. Always make sure you’re using products that are noncomedogenic, or not acne forming.

Sun may potentially improve acne for some people, because it can dry out the skin. But even small amounts of sunshine can irritate acne-prone skin. Also, some acne medications can make you more susceptible to harmful rays.

Here are a few precautions you can take to minimize damage from the sun:

  • Find out if your acne medications include warnings about the sun.
  • Keep vulnerable skin out of direct sunlight whenever possible.
  • Wear a wide-brimmed hat to protect your face and neck when outdoors.
  • Be sure to keep your chest and back covered if you tend to break out there. Wear soft, breathable fabrics, like cotton.
  • Ask your doctor which sunscreens are best for you.

Where acne lesions are inflamed, applying a lightweight, noncomedogenic sunscreen daily will help prevent hyperpigmentation. Most people with severe acne need to be on multiple topical medications, oral antibiotics, or isotretinoin (Accutane).

A variety of OTC medications can help with acne. They come in many forms, including creams, lotions, gels, soaps, and wipes.

Here are some things to keep in mind when choosing OTC products:

  • Helpful ingredients include benzoyl peroxide, adapalene, azelaic acid, salicylic acid, and sulfur (if you don’t have an allergy to sulfur).
  • For best results, always wash your skin before applying OTC products.
  • Follow the package directions when applying the product.
  • Be patient. It typically takes at least 3 months to see an improvement in acne.
  • Check the package insert, so you’re aware of potential side effects and how long they may last.
  • If you have severe side effects or your pain is increasing, stop using the product and call your doctor.

OTC acne medications might help you slightly. But if you have severe acne, you’ll probably need to visit a dermatologist to prevent scarring.

Cold and heat can help reduce swelling and make your pain less severe.

To reduce swelling of new blemishes with ice, you can:

  1. Wrap an ice cube in a towel.
  2. Hold in place for 10 minutes.
  3. Repeat up to three times.
  4. Take 10-minute breaks in between.

You can try these steps to apply a warm compress to new whiteheads:

  1. Soak a clean washcloth in warm water.
  2. Hold in place for 10 to 15 minutes.
  3. Don’t let the washcloth get too hot.
  4. Repeat this process three to four times per day until it releases the pus.

Severe acne rarely responds to OTC products or basic home care. This doesn’t mean you’re doing something wrong, but it does mean it’s time to contact a dermatologist. Visiting a dermatologist early on can prevent scarring.

A dermatologist is a doctor who specializes in treating acne and other skin conditions. They can put you on the right treatment plan for severe acne.

If you don’t have a board certified dermatologist, ask your doctor to refer you to one. You can also use the American Academy of Dermatology’s searchable database to find a doctor near you.

Talk with a dermatologist when:

  • OTC products or medications aren’t working.
  • Acne is getting worse or more painful.
  • Your skin appears to be infected.
  • Acne is starting to scar your face or leave dark spots.
  • Acne is affecting your self-esteem or causing emotional distress.

All inflammatory acne will leave dark spots when healing, just like a scratch or scar. However, this will go away over time. Most acne does affect self-esteem and causes distress, so it’s important to seek help early on.

Some of the medications and procedures your dermatologist might use are:


The American Academy of Dermatology says that antibiotics work by decreasing the bacteria on your skin. These medications also lower inflammation, so your skin will look clearer and have fewer breakouts.

Common antibiotics used for severe acne include:

  • minocycline
  • doxycycline
  • tetracycline
  • erythromycin
  • azithromycin
  • sulfamethoxazole-trimethoprim (Bactrim)

Both minocycline and doxycycline are in a class of drugs called tetracyclines, according to a 2020 research review. Avoid calcium products if taking these, because they can prevent tetracyclines from being absorbed. Doxycycline can cause increased sun sensitivity and an upset stomach. Minocycline can cause dizziness and also upset the stomach.

Antibiotics taken for too long can cause resistance and stop working, so your doctor may also prescribe another acne treatment like benzoyl peroxide while you are on these medications. If you have severe acne, they’ll typically also prescribe several topical medications.

Retinoid creams, gels, and lotions

Retinoids such as tretinoin are topical acne medications. They work by turning skin cells over faster, preventing dead cells from clogging pores. This can help reduce outbreaks.

A 2017 research review found that these medications may also reduce scarring and lessen changes in skin pigmentation that are the result of acne.

With retinoids, applying more is not better. Instead, apply a pea-size amount to your entire face at night or every other night as tolerated. Retinoids also have anti-inflammatory effects.

Steroid injections

The British Association of Dermatologists says that diluted steroids can be injected into inflamed acne lesions.

Injections are best for large spots. This is because they have inflammatory action that reduces the size of the lesion within 24 to 72 hours.

Steroids don’t treat acne’s underlying causes. They’re not a long-term treatment strategy.

Oral contraceptives

Sometimes hormones are the underlying cause of acne. A 2017 research review found that oral contraception works on acne by using estrogen to work against androgen levels in the body.

People commonly refer to oral contraception as birth control. This comes with some side effects and potential risks, like increased risk of blood clots, deep vein thrombosis, or premenstrual migraines. Your doctor can discuss these with you.


Another medication that may treat hormonal acne is spironolactone. Spironolactone is a potassium-sparing diuretic, a kind of water pill. It blocks the surge of a male sex hormone premenstrually which causes hormonal acne. All medications have possible side effects, so it’s important to discuss them with your dermatologist.

Laser or light therapy

DermNet NZ says that light therapy works by sending wavelengths into the skin at different depths depending on the kind of light. The American Society for Dermatologic Surgery adds that laser therapy is also an option to resurface skin scarred by acne.

Light therapy often takes several treatments, and is not a complete cure for acne, according to the American Academy of Dermatology.

Prescription chemical peels

Chemical peels work by removing the outer layers of skin to reveal the skin underneath. They use exfoliating agents that can perform a superficial, medium, or deep peel.

A 2018 study suggests that people with darker skin may be more likely to experience hyperpigmentation from a chemical peel. If you have darker skin, you may want to avoid deep peels.

Drainage and extraction to remove acne cysts

The American Academy of Dermatology says that a doctor may use a sterile needle or blade to open an acne cyst and remove the contents. A dermatologist can do this the right way, so the acne is removed and heals properly.

Experts don’t recommend at-home “pimple popping.” This can increase inflammation or lead to infection, making the acne worse.


If your acne doesn’t respond to other treatments, your doctor may prescribe isotretinoin. Dermatologists recommend isotretinoin for acne that causes deep and painful cysts. Isotretinoin is also known by several brand names, including Accutane.

Isotretinoin is a form of high-dose vitamin A. If a person has severe cystic acne, doctors now use it as first-line therapy to prevent scarring.

Because of the risk of serious side effects, your doctor will monitor you closely while you take isotretinoin.

When washing your face, use your hands only. Don’t scrub or use a washcloth, mesh sponge, or any other material that can irritate your skin.

Avoid using harsh products that include the following:

  • abrasives
  • alcohol
  • astringents
  • exfoliants
  • fragrance
  • toners

Also, consider avoiding:

  • acne concealers
  • facial scrubs or facial masks
  • products that are oily or greasy
  • indoor tanning beds or other tanning devices

It’s easy to get carried away in your quest to get rid of acne. Excessively washing or scrubbing your skin can irritate it more.

When you have an outbreak, try to keep your hands off of your face. It may be tempting, but picking at or squeezing pimples can lead to pain, infection, and scarring. Let your face heal naturally or let your dermatologist handle it.

Earbud cords, phones, helmets, and straps can create friction or put pressure on sensitive skin on your face, hairline, and neck. If you have acne on your back or chest, try to prevent your backpack or purse straps from touching it.

Also, be sure to wash your pillowcases and reusable face masks several times a week, or wear disposable masks.

Be wary of products that make extraordinary claims. Certain alternative and complementary treatments can be effective. However, it’s a good idea to check with your doctor before trying them.

Even 100 percent natural products can interact with other treatments. Sometimes, this can make your acne worse or cause other side effects.

Severe acne can be stubborn, but you don’t have to accept it as your “normal.” There are ways to successfully manage acne, clear your skin, and lower the chances of permanent scarring or discoloration.

See a dermatologist as soon as you can for severe acne. This kind of acne rarely, if ever, clears up with over-the-counter medications.