Severe forms of acne affect few people. However, these conditions are very hard to bear by those who are indeed affected. They are extremely disfiguring and are usually accompanied by psychological effects.



Acne conglobata
Acne conglobata is a chronic and severe form of acne vulgaris (common acne). It is usually characterized by deep abscesses, severe inflammation, severe damage to the skin and scarring. Blackheads are usually conspicuous and widespread. It often appears on the face, chest, back, thighs, upper arms and buttocks. It usually affects people between the ages of 18 and 30.

In acne conglobata, inflammatory nodules form around multiple comedones, gradually increasing in size until they break open and discharge pus. Deep ulcers may form under the nodules, leading to keloid-type scars, and crusts may form over deeply ulcerated nodules.

Acne conglobata may be preceded by acne cysts: papules or pustules that do not heal, but instead rapidly deteriorate. Occasionally, acne conglobata flares up in acne that had been dormant for many years.

Acne fulminans
Acne fulminans is a sudden onset of highly destructive inflammation, which normally afflicts young men. Symptoms of severe nodulocystic, often ulcerating acne, aching joints and fever are apparent. It may result from unsuccessful treatment of acne conglobata. It does not respond well to antibiotics, so accutane and oral steroids are normally prescribed. 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.

Gram-negative folliculitis
Gram-negative folliculitis is a complication of abused and long-term use of antibiotics. Patients with this type of acne are usually treated with accutane since it is known to be effective against gram-negative bacteria. The word “Gram” refers to a blue stain used in laboratories to detect microscopic organisms. Certain bacteria do not stain blue and so they are called “Gram negative.”

Pyoderma faciale
Pyoderma faciale is the type of acne that affects females, mainly from the 20-40 age group. It is confined to the face, appears suddenly as both deep and superficial cystic lesions of the face with interconnecting "tunnels" between cysts, reddish inflammation of the skin, and slight swelling (edema) of the skin. It rarely persists more than a year or so, and is not associated with oily skin.


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