Nodulocystic acne is a severe form of acne affecting the face, chest and back.
Nodulocystic acne is characterised by multiple inflamed and uninflamed nodules and frequently, scars. It is more common in males.
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Acne conglobata is an uncommon and unpleasant form of nodulocystic acne in which there are interconnecting abscesses and sinuses, which result in unsightly hypertrophic (thick) and atrophic (thin) scars. There are groups of large macrocomedones and cysts that are filled with smelly pus.
It is occasionally associated with hidradenitis suppurativa, a condition in which similar boil-like lesions and scars occur in the armpits, groins and under the breasts. Nodulocystic acne may very rarely be a manifestation of a genetic disorder, PAPA syndrome.
The recommended treatment for nodulocystic acne is isotretinoin, which should be commenced early to prevent scarring. The treatment is required for at least five months, and further courses are sometimes necessary. Patients with acne conglobata often need additional oral antibiotics and intralesional or oral steroids.
When isotretinoin is unavailable or unsuitable, systemic antibiotics, and in women hormonal therapy, may also be effective.
Topical treatment is usually ineffective.