Acne is one of the most universal forms of skin problems. Both men and women can suffer acne, but usually only during adolescence. However, there are some kinds of acne that are more severe than others and can have serious consequences for the skin.

If acne becomes severe, it may take a long time to heal. Some types of severe acne can also cause deep abscesses and scars after the lesions have healed.

The main type of severe acne vulgaris is called acne conglobata. In acne conglobata, infected nodules form around comedones. The nodules become more inflamed and spread deep below the skin surface. When these nodules burst, they produce deep scars. Blackheads are very common in this type of acne. It can form on buttocks, face, trunk, etc. The treatment of acne conglobata is commonly performed with isotretinoin.

Other insidious kinds of acne are acne fulminans and gram-negative folliculitis. If acne suddenly flares up leaving inflammation, ulcers, and fever, it is called acne fulminans. This is generally treated with steroids. Gram-negative folliculitis, on the other hand, is a harsh type of folliculitis that harms the hair follicle and infects the pore. Isotretinoin is the treatment of choice for this type of skin problem.

Any acne condition that keeps flaring up instead of subsiding can turn into a form of severe acne. One of the main consequences of severe acne can be deep acne scars as well as swelling, redness and irritation. If you suffer from any form of severe acne, you must be under the care of a doctor.

The Solution

When dealing with acne skin care, the best treatment methodology is to treat as many of the causes as possible.

Excessive Sebum Production

Excessive sebum production begins in puberty due to hormonal changes. The rising levels of androgens, the major sebotrophic hormones, begin to increase sebum production. However, while androgenic stimulation is crucial in the pathogenesis of acne, the common acne sufferer does not have major endocrine alterations. Hormonal therapy is not recommended in the early treatment of mild to moderate acne, although women who need oral contraception may be candidates for anti-androgen therapy early in the course of treatment.

Abnormal Desquamation of the Follicular Cells

In acne, keratinocytes hyperproliferate and gather inside the sebaceous follicle. As these abnormally desquamated cells gather in the sebaceous follicle, they lead to microcomedo appearance. The microcomedo is the precursor to all acne lesions and is present in 4 out of 5 acne papules but is not evident to the naked eye. However, as the already clogged follicle starts to fill with lipids, bacteria and cell fragments, the microcomedo changes to open or closed comedones (blackheads and whiteheads, respectively), both of which are non-inflammatory lesions. If P. acnes proliferate, inflammatory elements are created and inflammatory papules and pustules occur.

Bacterial Proliferation

With acne problems, the microenvironment of the follicle is conducive to the population of P. acnes. This causes inflammation and the production of the visible papules and pustules with which acne sufferers typically present to dermatologists.

Inflammation

Inflammation in acne appears as a consequence of hormonal and cellular defensive responses to the proliferation P. acnes. It has been suggested that changes in sebum production or composition irritate infundibular keratinocytes causing the production of interleukin 1a (IL-1a). Also, CD4 lymphocytes and neutrophils migrate to the follicle. Rupture of the follicular duct causes the extravasation of lipids, corneocytes and bacteria into the skin, causing further inflammation.