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The four major types of severe acne include acne congolbata, acne fulminans, gram-negative folliculitis, and nodulocystic acne. Most afflict teenage boys and young men. All of them can cause serious skin damage and scarring. Treatment may include antibiotics, isotretinoin, or oral contraceptives. The lesions are often very hard to treat; patience and several months of consistent treatment may be required.
Acne conglobata is a type of severe acne that is characterized by blackheads, scarring, severe damage to the skin, inflammation, and deep abscesses. Males between the ages of 18-30 years old are more often afflicted with this type of severe acne. It may develop on the face, neck, trunk, upper 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 brought on by abusing anabolic-androgenic steroids.
The lesions in acne conglobata tend to be very large and appear in groups. As the lifecycle of the lesions progress, pus develops and eventually lesions scab and slowly heal. Irregularly shaped keloid, or raised, and atrophic, or flat, scars are left behind. Acne conglobata may respond to isotretinoin, also known as Accutane in the U.S. Antibiotics may also be prescribed alone or in conjunction with the isotretinoin.
Acne fulminans is characterized by the sudden appearance of severe, ulcerating lesions that may be 1/2 to 2 inches (1.3-5.08 cm) across. This condition starts with aching joints, progresses to include swollen lymph nodes in the neck, and is followed by stiffness. As the swelling decreases in the nodes, there is increased joint swelling and inflammation. This severe acne condition usually appears in boys at the onset of puberty. It may appear following treatment of acne conglobata.
It is important to seek medical treatment immediately to avoid hospitalization. The usual treatment is two-pronged. Nonsteroidal anti-inflammatories such as ibuprofen, or corticosteroids, may be prescribed to reduce inflammation. Isotretinoin may be prescribed for the lesions. Antibiotics are not very effective against acne fulminans, however. Even after the condition is cleared up, the acne may reappear later in life.
Another severe acne condition is gram-negative folliculitis. It consists of superficial pustules and deep, cystic lesions across the nose, chin, and cheeks. A rare bacterial infection, it is thought to be a complication of long-term antibiotic use. It may also be brought on by hot tub use and swimming pools. Gram-negative folliculitis is usually treated with isotretinoin.
Nodulocystic acne may develop in both males and females. This condition causes painful cysts, or nodules of inflammation, that can be several centimeters across, and which may cause severe scarring. Lesions typically occur on the face, neck, back, scalp, chest, and shoulders. Treatment consists of isotretinoin and antibiotics, or injections of corticosteroids directly into the lesions; young women may take oral contraceptives to help clear the acne. If cysts do not respond to treatment, they may need to be surgically drained and removed by a dermatologist.