This young man has grade 4 acne, which is the most severe. My first recommendation would be to talk with his family doctor or one you work with and get him on an oral antibiotic. The preferred medication is Minocycline 100 mg twice daily. I would use it only for ten days or two weeks. It can be repeated later if needed.

By using this for only a limited time, it minimizes build-up of resistant bacteria. Minocycline is in the antibiotic group of tetracyclines, works well with acne, and is less likely to develop resistance in bacteria. Minocycline should control the active infection and decrease pustules.

Secondly, I would start him on Jessner peels to open/unroof the pustules so healing can occur. Open lesions can heal with minimized scarring. I would suggest repeating Jessner peels every two weeks for a series of 5 peels or so. Then let the skin take a break for a month or so. If needed, repeat a series of peels.

Next, I would have him begin using the Reversion system twice daily. When a new lesion is beginning to develop (red tender spot) use the spot treatment on just that area at night before bed and after washing face.

Take photos every two weeks or so to monitor progress. I think this will help the young man very much. Hopefully, he will outgrow the acne problem when hormones level out with maturity.