Nodulocystic acne

What is nodulocystic acne?

Nodulocystic acne is a severe form of acne affecting the face, chest and back. It is characterised by multiple inflamed and uninflamed nodules and frequently, scars. It is more common in males.

The name implies there are nodules (firm lumps) and cysts (fluid-filled cavities lined by epithelium). However, the fluctuant lesions are not true cysts as there is no lining. They are sometimes called pseudocysts.

More images of acne ...

• Facial acne
• Back acne

What is acne conglobata?

Acne conglobata is an uncommon and unpleasant form of nodulocystic acne in which there are interconnecting abscesses and sinuses (channels under the skin). These result in unsightly hypertrophic (thick) and atrophic (thin) scars. There are groups of large macrocomedones and cysts that are filled with smelly pus.

Acne conglobata is occasionally associated with:

• Other disorders associated with follicular occlusion, particularly 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.

What is the treatment for nodulocystic acne?

Treatment of nodulocystic acne can be challenging and may require a combination of medicines. Topical treatment is usually ineffective.

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 treatments, such as:

• Oral antibiotics
• Intralesional steroids
• Systemic steroids
• Hormonal therapy in women