Run-of-the-mill acne is common enough to be seen as an adolescent rite of passage. But some types of acne are far more severe than a typical case. Prompt treatment from a dermatologist is essential in order to avoid or minimize the extensive tissue damage that these abnormal acne forms can cause.
Nodulocystic acne features highly inflamed cyst-like nodules that can measure a few centimeters in diameter. In some cases these cysts grow together and break down, causing tunnels to form under the skin surface, in what is known as acne conglobata. Yet another form of severe acne, called acne fulminans, also involves significant inflammation, but it develops suddenly. The acne lesions often ulcerate and you are likely to experience whole-body symptoms, including fever and aching joints. And finally, if you have been on long-term antibiotic treatment, you can develop gram negative folliculitis, in which the hair follicles become infected and inflamed in a rash pattern.
Four factors play into acne: excess sebum oil, blocked pores, bacteria and inflammation. Nodules and cysts result from the vicious inflammation that develops with a deep blockage. Exactly why some people are prone to this type of acne is not clear to scientists. Genetics and hormones both seem to play a role, according to the American Academy of Dermatology. Gram negative folliculitis is a special case. Scientists know that it develops as a result of Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens or other bacteria species that can proliferate after treatment with tetracycline or topical antibiotics.
While mild acne may be, for the most part, an annoyance, severe acne can have profound effects. Because of the stress and embarrassment it brings, the condition can interfere with a person's social life. The disastrous impact it has on self-confidence can even limit a sufferer's career trajectory. Additionally, all forms of severe acne can cause scarring, including deep and irregular scars.
The oral medication isotretinoin, frequently sold under the name Roaccutane and formerly as Accutane, is a mainstay of treatment for severe acne. Oral antibiotics are also in common use. In the case of acne conglobata, "several courses of treatment may be necessary over a period of years," according to the American Academy of Dermatology. Corticosteroids can usually cause an acne cyst to resolve over three to five days if injected directly into the lesion. The largest and most serious lesions may merit drainage and surgical excision by a dermatologist.
Isotretinoin is the most effective acne medication known, according to the American Academy of Dermatology, but it is not a solution everyone can take advantage of. Its use is limited among women of childbearing age because of its potential to cause severe birth defects. Other possible side effects include headaches, vomiting, thinning hair and a rise in cholesterol.
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