Isotretinoin Treatment for Severe Acne Cases



Acne is the development of blackheads, whiteheads, pustules, or cysts. This skin condition is most common in teenagers, but can also occur in adults and children.


Dead skin cells and oils travel up to the surface of the skin through pores. Sometimes there is too much of an oil, called sebum. The extra sebum causes dead skin cells to stick together and block the pore. This is what causes acne. Bacteria can also become trapped in the pore and cause an infection. The infection causes the familiar redness and pus. It can also spread down into the skin and cause cysts.

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Blackheads are clogs that reach the skin's surface. Whiteheads are clogs that stay beneath the surface of the skin. Small red bumps, pimples, and cysts may develop if bacteria is causing an infection.

Risk Factors

Factors that may increase your chances of acne:

  • Family history
  • Changes in hormone levels which can occur with:
    • Puberty
    • Pregnancy
    • The time before a menstrual period
  • Stress
  • Certain cosmetic products especially those that are greasy



Acne symptoms vary from person to person and can range from mild to severe. They include:

  • Excess oil in the skin
  • Blackheads
  • Whiteheads
  • Papules—small, pink bumps that may be tender to the touch
  • Pimples—inflamed, pus-filled bumps that may be red at the base
  • Nodules—large, painful, solid lumps that are lodged deep within the skin
  • Cysts—deep, inflamed, pus-filled lumps that can cause pain and scarring


The areas of your skin most likely to develop acne will be examined. The doctor can make a diagnosis based on physical exam.

If your acne is severe, you may be referred to a dermatologist.



Acne will require a combination of treatments. Most treatments may take several weeks to work. Your skin may actually appear to get worse before it gets better.

It is also common to have to change treatments during recovery.


Medications to treat acne include:

  • Over-the-counter topical medications such as cleansers, creams, lotions, and gels to reduce the amount of oil and/or bacteria in the pores.
  • Prescription topical antibiotics or retinoids to reduce the amount of oil and/or bacteria in the pores.
  • Oral antibiotics to control the amount of bacteria in pores.
  • Medications to control certain hormone levels.
  • Oral retinoids to reduce the size of oil glands. This medication is only used for severe cases of cystic acne.
    • Must not be taken by women who are pregnant or who may become pregnant due to the risk of serious birth defects.
    • Potential complications need to be followed with frequent examinations and blood work.


There are a number of procedures that can be used by your doctor or dermatologist to treat acne:

  • Corticosteroids—an injection of corticosteroid directly into the cyst mostly used for large, cystic acne lesions
  • Acne surgery
  • Chemical peels—uses glycolic acid and other chemical agents to loosen blackheads and decrease acne papules
  • Dermabrasion —used to treat deep acne scars
  • Scar excision—used to reduce or improve the appearance of acne scars
  • Collagen fillers—used to add volume to acne scars to make them appear more smooth
  • Light and laser therapies

Some of the procedures have risks such as scarring and infection.

Home Care

To decrease irritation of your acne:

  • Gently wash your face with mild soap and warm water no more than twice a day to remove excess oil. Scrubbing or washing too often can make acne worse.
  • Allow your face to dry before applying any lotion.
  • Do not pick at or squeeze blemishes.
  • Use lotions, soaps, and cosmetics labeled noncomedogenic. This means it will not clog your pores.
  • Use topical acne treatments only as directed. Using them more often could make your condition worse.
  • Recognize and limit emotional stress whenever possible if it triggers your acne.
  • Wear sunscreen year-round. This is especially important if you are using medication that can make your skin more sensitive to the sun.


Acne is caused by changes in your body's processes so it is difficult to prevent. Acne is not due to improper hygiene.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Pimples; Blackheads; Whiteheads; Acne Vulgaris)



American Academy of Dermatology 


Canadian Dermatology Association 


Acne. EBSCO DynaMed Plus website. Available at:  . Updated June 27, 2017. Accessed December 15, 2017.

Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: Updated September 1, 2016. Accessed December 15, 2017.

Acne: overview. American Academy of Dermatology website. Available at: Accessed December 15, 2017.

10/20/2012 DynaMed Plus Systematic Literature Surveillance  : Arowojolu A, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012;(7):CD004425.