Severe acne includes acne conglobata, acne fulminans, gram-negative folliculitis, and nodulocystic acne. They can cause skin damage and scarring, and treatment may include antibiotics, isotretinoin, or oral contraceptives. Lesions can be difficult to treat and may require patience and consistent treatment.
The four main types of severe acne include acne congolbata, acne fulminans, gram-negative folliculitis, and nodulocystic acne. Most boys and young people afflict. All of them can cause severe skin damage and scarring. Treatment may include antibiotics, isotretinoin, or oral contraceptives. The lesions are often very difficult to treat; patience and several months of consistent treatment may be required.
Acne conglobata is a type of severe acne characterized by blackheads, scarring, severe skin damage, inflammation, and deep abscesses. Males between the ages of 18 and 30 are most often affected by this type of severe acne. It can develop on the face, neck, trunk, arms and/or buttocks. The underlying causes of acne conglobata are unknown, but there appears to be a genetic component. This type of severe acne can also be caused by anabolic androgenic steroid abuse.
The lesions in acne conglobata tend to be very large and appear in clusters. As the life cycle of the lesions progresses, pus develops and eventually the lesions form and slowly heal. Irregularly shaped, or raised, and atrophic, or flat keloid scars are left. Acne conglobata may respond to isotretinoin, also known as Accutane in the United States. Antibiotics may also be prescribed alone or in combination with isotretinoin.
Acne fulminans is characterized by the sudden appearance of severe, ulcerative lesions that may be 1-2 cm in diameter. This condition begins with aching joints, progresses to include swollen lymph nodes in the neck, and is followed by stiffness. As the swelling decreases in the nodes, the swelling and inflammation in the joints increases. This serious acne condition usually appears in boys at the onset of puberty. It can appear after the treatment of acne conglobata.
It is important to seek medical treatment immediately to avoid hospitalization. The usual treatment is twofold. Nonsteroidal anti-inflammatories such as ibuprofen or corticosteroids may be prescribed to reduce inflammation. Isotretinoin may be prescribed for injuries. However, antibiotics are not very effective against acne fulminans. Even after the condition has resolved, acne can reappear later in life.
Another serious acne condition is Gram-negative folliculitis. It consists of superficial pustules and deep cystic lesions on the nose, chin and cheeks. A rare bacterial infection, it is thought to be a complication of long-term antibiotic use. It can also be caused by using the hot tub and swimming pools. Gram-negative folliculitis is usually treated with isotretinoin.
Nodulocystic acne can develop in both males and females. This condition causes painful cysts, or lumps of inflammation, which can be several centimeters in diameter and which can cause severe scarring. Lesions typically occur on the face, neck, back, scalp, chest, and shoulders. Treatment is isotretinoin and antibiotics or corticosteroid injections directly into the lesions; young women can take oral contraceptives to help clear acne. If the cysts don’t respond to treatment, they may need to be surgically drained and removed by a dermatologist.
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