Severe acne can refer to a number of presentations of acne with complications. It typically involves acne that is widespread in distribution, often causing deep seated lesions with complications such as an abscess, keloid scarring and may be unrelenting despite numerous OTC (over-the-counter) treatments and prescription medication.
Severe acne is relative term – since the degree of acne can vary from one person to another, a mild case of acne can seem severe when compared to a person with single isolated pimple (papule).
Inflammatory and Non-Inflammatory Acne
Acne vulgaris involves a number of different lesions. The formation of a plug and blockage of a pore may initially present with a whitehead (closed comedone ~ completely blocked) or blackhead (open comedone ~ partially blocked). These plugs (keratin + sebum + sometimes dust) are lodged deeper in the duct in a whitehead or more superficially in a blackhead. A combination of oxidation and bacterial breakdown products causes the black color seen in blackheads. There is no inflammation of the skin at this point.