Severe Acne: 4 types
Severe acne can affect many
facets of a person’s life, causing a great deal of embarrassment and
stress. Severe acne may significantly limit one’s social life and
even interfere with opportunities for employment. Since this
condition can be disfiguring and require years of treatment, it is
important to see a specialist. Dermatologists have the most
experience treating the different types of severe acne.
Four types of severe acne, described in
detail below, are:
Acne conglobata is a chronic and severe form of
Severe damage to the skin
comedones) are usually conspicuous and widespread—often
occurring on the face, neck, trunk, upper arms and/or buttocks
In acne conglobata, inflammatory
nodules form around
multiple comedones, gradually increasing in size until they break
down and discharge pus. Deep ulcers may form under the nodules,
leading to keloid-type
scars, and crusts may form over deeply ulcerated nodules
Burrowing abscesses commonly result in
deep, irregular scarring.
Acne conglobata may be preceded by acne
pustules that do not
heal, but instead rapidly deteriorate. Occasionally, acne conglobata
flares up in acne that had been dormant for many years.
Males are more likely than females to
have acne conglobata; the age of onset is usually between 18 and 30
years. The cause of the condition is not well understood.
the usual treatment of choice for acne conglobata. Antibiotics may
also be prescribed. Several courses of treatment may be necessary
over a period of years. Even after effective treatment, the patient
should have regular checkups by a dermatologist for any signs of
recurrence. A dermatologist can also treat the scars.
Acne fulminans is a sudden onset of highly destructive inflammation.
It appears suddenly in a person with inflammatory acne and is
Symptoms of severe and often
Inflammation and aching of joints,
especially hips and knees
A person who develops acne fulminans
may have had unsuccessful treatment for another form of severe acne,
Treatment. Corticosteroids or
non-steroidal anti-inflammatory medications may be given to reduce
inflammation. Attacks of acne fulminans may recur, and the patient
may develop acne that requires long-term treatment with isotretinoin.
Cysts are relatively uncommon in acne; however, this form of severe
acne is characterized by cysts, which may measure several
centimeters in diameter as seen in these two photos:
Cysts may develop singly or be widespread as these photos show
(Photos used with permission of the American Academy of
National Library of Dermatologic Teaching Slides)
Cysts may occur singly, or be
widespread over the face, neck, scalp, back, chest and shoulders.
And, they can be painful.
The nodular cyst of acne is not a true
cyst—an abnormal dilatation of a normal skin structure. Acne cysts
are nodules of inflammation. The cysts may arise from a
nodular acne lesion,
or occasionally from a type of cyst that develops in the outer layer
of the skin—a type of cyst not usually associated with acne. A cyst
may appear to be filled with thick, yellow pus-like fluid. This is
usually an inflamed and infected cyst. If an attempt is made to
drain such a cyst, it should be done in a physician’s office under
sterile conditions, not in front of a bathroom mirror.
Cysts occurring close together may
coalesce, producing soft areas undermined with tunnels, cell
destruction and inflammation, resulting in another form of severe
Treatment. Nodulocystic acne
usually requires an aggressive treatment regimen that may include
isotretinoin and antibiotics, or intralesional corticosteroids that
"melt" the cyst over a period of 3 to 5 days. Some very large
follicular cysts that do not respond to medications may require
drainage and surgical excision.
Gram negative folliculitis is an inflammation of follicles caused by
a bacterial infection that can result from long-term antibiotic
treatment. Patients who are being treated with antibiotics for
severe acne may develop Gram negative folliculitis.
The word “Gram” refers to a blue stain
used in laboratories to detect microscopic organisms. Certain
bacteria do not stain blue and are called “Gram negative.”
Treatment. In Gram negative
folliculitis, the bacteria are resistant to many antibiotics.
Isotretinoin and antibiotics that are effective against Gram
negative bacteria are used to treat this condition.
Anyone with severe acne should be under
the care of a dermatologist as dermatologists have the experience
needed to control virtually every case of acne.
It is important for patients and their
families to know that severe, disfiguring forms of acne may require
years of treatment and patients can experience one or more treatment
failures. During treatment, the support of family and friends can
greatly comfort patients. Information sources, such as AcneNet, may
help family and friends to better understand what those with severe
acne face every day.
content solely developed by the American Academy of Dermatology