The mechanism of action of antibiotics for acne is not perfectly clear as these agents are not only antimicrobial:

• They diminish inflammatory cell chemotaxis;
• Modify the complement pathways and
• Inhibit the polymorphonuclear leukocyte chemotactic factor' and lipase production in P. acnes.

Combinations of comedolytic agents and antibiotic agents are beneficial for the majority of these acne patients.

Sever acne that unresponsive to several systemic antibiotics and characterized by mainly nodular lesions may be a good candidate for systemic isotretinoin therapy.

Another approach for the acute treatment of painful nodules is intralesional corticosteroid injection. If patients spend a great deal of time picking their skin, decreasing their fixation is an essential component of therapy.

This may be accomplished with behavioral interventions, intensive medical therapy for the acne, or in extreme cases, treatment for obsessive-compulsive traits or disease.