What to do if your acne is severe? Here are a couple of avenues to explore:
Photodynamic therapy. Approved for treating precancerous skin lesions, this therapy is increasingly being used off-label for acne. First, a photosensitizing solution is painted onto the skin and left to sit for about an hour. Once absorbed, it's activated by a special blue light that shines on patients for eight to 12 minutes. There's an oil-gland-stunning, bacteria-killing result, but experts say there's also a drawback. "You really have to avoid sunlight and light in general for the next 24 hours," or you may blister, says dermatologist Doris Day, author of 100 Questions & Answers About Acne. "But otherwise, it's good."
Isotretinoin: Marketed as Accutane, this drug is the "gold standard" treatment for severe acne, says Amy Derick, a dermatologist in Barrington, Ill. It shrinks the oil glands and leaves approximately three-fourths of those who use it pimple-free. But its effectiveness comes with some potential downsides, which is why patients must be strictly monitored throughout the treatment course. Women, for example, must be on two forms of birth control to ensure they won't get pregnant, because the drug can cause severe birth defects. It's also associated with an increased risk of depression and suicide, though no definitive causal link has been proven.