In this segment, I will talk about the treatment of severe or cystic acne, and I will give you a broad overview of the different modalities that I will discuss at a later segment in more detail. Severe or cystic acne, as the name already implies, is mostly made up of cystic lesions inside the skin, inflammatory papules, pustules, sometimes the are confluent and form abscesses. It is very, very important to turn off this inflammation as quickly as possible in order to avoid terrible scarring on the skin. The treatment options for severe cystic acne ar sotretinoin, better known as Accutane; photodynamic therapy; oral antibiotics given for a short period of time and matched with a topical regiment that can further subdue and then also maintain reduced acne; and in women, there's a possibility of treatment with an agent known as spironolactone, which is not FDA-approved for the treatment of acne, but rather for the treatment of high blood pressure, but has for a number of decades now been used for the treatment of severe cystic acne. Just to be complete, I would like to mention that sometimes oral contraceptive pills in women can reduce acne as well and may show you this type of improvement when you're already taking these medicines. In my practice, I do not start treatment with oral contraceptive treatment, because there are many other choices that I can resort to. In addition to these medicines and/or more dramatic treatments that I've just mentioned, ancillary treatments are also used to tame the acne, such as red light treatments, pulsed dye laser treatments, and smooth beam treatments. All of those treatment modalities, with the exception of Accutane, are oftentimes used in concert and not by themselves in order to really subdue the process.