Severe Acne Treatments

If you have severe acne, you will need help from your family doctor or a dermatologist. A dermatologist can be seen with a referral from a family doctor or from a physician at a walk-in clinic. Medical treatment focuses on:

• Healing existing spots and lessening the risk of scarring; preventing future acne spots and scarring.


Options include (some listed in Moderate acne treatment section with a link here):

Girl in front of wire fence outside, smiling at the camera

A combination topical treatment

Treatment: A gel that combines adapalene 0.3% and benzoyl peroxide 2.5%. This treatment was approved by Health Canada in November of 2015 for moderate to severe acne. It may be suitable for those with severe acne who are unable or unwilling to take an oral (pill) therapy. In a 12-week clinical trial of patients with severe acne, there was an average reduction in inflammatory lesions – papules (red bumps), pustules (pimples), nodules and cysts – of 74.4%. Some 31% of patients were rated as “clear” or “almost clear” of acne after 12 weeks of treatment.

How does it work? Adapalene is a retinoid. Retinoids normalize the excess shedding of skin cells to prevent plugging of pores resulting in a reduction in blackheads, whiteheads and inflamed spots. Benzoyl peroxide kills bacteria in acne spots and helps reduce inflammation (redness, swelling etc).

Side effects: Dryness, scaling, stinging and redness have been reported in the first couple of weeks of treatment. However, these effects usually taper off. Gradual introduction of the treatment, good moisturizing and gentle cleansing help reduce or prevent irritation. For more, see 7 tips – How to apply prescription topical retinoids. Read all drug safety information provided.

Dos and don’ts: Not for those who are pregnant, breastfeeding or trying to become pregnant. May bleach hair (apply carefully around the hairline) and coloured fabric such as clothing or bedding. Minimise sun exposure, use sun protection, avoid tanning booths and exposure to extreme weather (cold, wind etc).

Expect results: Initial results seen at 2-3 weeks with maximum improvement at 12-16 weeks.

Back to treatments list

Group of teens standing in a line outside


Treatment: For those with severe acne, or stubborn acne that has not responded to other treatments, or for adult acne of a moderate or severe degree, this oral medication, a potent, synthetic form of Vitamin A offers an effective, long term solution. In about 40 – 60% of cases, only 1 course lasting about 6 months is all that is ever needed.

However, this medication can cause severe birth defects. Females taking this medicine have to follow the Pregnancy Prevention Program which involves using 2 forms of birth control to avoid any chance of becoming pregnant.

Those taking this drug also have to be monitored for possible cholesterol and liver problems. Most of these side effects disappear within a month of finishing treatment as the drug naturally passes through the system.

Health Canada recently approved a new micronized formulation of isotretinoin to treat severe acne in patients 12 years of age and older. Micronization – reducing the particle size of the drug – improves absorption and hence allows for the use of lower doses. The lidose formulation enhances absorption when taken with or without food.

How it works

Isotretinoin works on all the causes of the condition. It reduces oil gland activity, bacteria, inflammation and normalizes skin shedding.

Side effects: Dry skin, dry eyes, lips, nostrils, mood changes, higher cholesterol levels, liver problems, joint inflammation, reduced night vision. Most side effects disappear within a month of completing treatment. Can cause birth defects (see details above). There has been some debate about isotretinoin causing depression or inflammatory bowel disease, but scientific opinion on this is mixed.

Dos and Don’ts: Moisturize your skin several times a day and use lip balm. If you have dry eyes, use artificial tears. Use a sunscreen and sun protection as your skin will be over sensitive to the sun during the summer months.

Results: Within 4 – 6 months. Some improvement will be evident in many people after 2-3 months.

Back to treatments list

Woman in grey blazer smiling at camera

Corticosteroid Injections

Corticosteroid injections: For those with severely inflamed cysts, synthetic versions of hormones are injected into these lesions. The injections are used for a limited time only due to various reasons.

How it works: synthetic hormones alter the body’s immune response, reduce inflammation and help with healing.

Side effects: Since these can only be used for a limited time, your doctor will discuss a treatment plan and side effects with you. Too high a concentration can cause a significant depression in the skin that may be permanent

Results: less inflammation and pain in cysts usually within a few days.

Back to treatments list

Boy in navy polo smiling in front of a white background

Photodynamic Therapy (PDT)

Photodynamic therapy (PDT): Can be an option for some with moderate to severe acne who do not wish to take oral medication. However, this treatment may be associated with moderate to severe side effects including pain and there may be considerable downtime. For some, a single PDT treatment may work and last for many months. For others, more frequent treatments are needed. More research needs to be done on the effectiveness of this treatment.

How it works: Light sensitive compounds are applied to the skin and then exposed to certain wavelengths of light – red or blue for example. Once activated by light, the compounds damage the oil glands or reduce bacteria.

Side Effects: Considerable pain, redness, swelling, crusting.

Results: 6– 8 weeks

Back to treatments list

7 Tips – How to apply prescription topicals containing retinoids.

Retinoids or combination treatments with retinoids can irritate the skin. Correct use will maximise effectiveness and limit skin reactions.

  1. Use at night (generally). Cleanse your skin, pat dry. To lessen risk of irritation (burning, stinging or itching), wait 10 – 15 minutes or longer if possible before applying the medication.
  2. Apply a small, pea-sized amount of product to each main area of the face – 1 for nose and chin, 1 for each cheek, 1 for forehead etc.
  3. Gently massage all over the affected area – not just spots – to prevent new spots from forming. Avoid eyes, mouth and nostrils.
  4. Use every other night to start. If well tolerated over time, increase to every night.
  5. Consider applying a moisturizer in the morning after the overnight application of the retinoid to reduce risk of skin dryness.
  6. If you develop irritation or stinging, stop treatment for 1-3 days, gently cleanse and moisturize in the meantime, and restart your topical medication applying it for 30 to 60 minutes for a few days before leaving it on for more prolonged times.
  7. Make application part of your daily routine by placing medications where you can easily see them, using around the same time every day and setting up self-reminders on your phone.

Take the Acne Quiz

Test your acne knowledge. You may be surprised at some of the answers…

Take the quiz