The common acne is called Acne Vulgaris. There are other types of acne that can be very severe. They are: Acne Conglobata, Acne fulminans, and Gram-negative folliculitis
All of these are very severe forms of acne and can be psychologically destructive. But with quick diagnosis they can be treated successfully.
Acne conglobata (AC) is an uncommon and unusually severe form of acne characterized by burrowing and interconnecting abscesses and irregular scars (both keloidal and atrophic), often producing pronounced disfigurement.
In this condition, blackheads are very widespread. Nodules with inflammation form around blackheads. These nodules increase in size rapidly and burst open after sometime. The nodules cause lot of skin scarring and reach the depth of the skin with infection. These are ulcerating nodules and may cause lot of pain and discomfort.
This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. Although the cause of this type of acne is unknown, it is associated with testosterone and thus appears mainly in men. There is a tendency for it to run in families and there is an association with certain HLA antigens. It forms mainly on the trunk, buttocks, and upper arms.
The most common treatment for this kind of acne is isotretinoin and antibiotics, and maybe combined with prednisone. The treatment is normally prolonged and may be repeated often. Surgery may be needed for large lesions.
Acne fulminans is a severe form of acne conglobata that appears suddenly. The acne in this case is very severe and ulceration is present. There is fever and inflammation of the joints, especially hips and knees.
Testotestrone that is taken for weight gain may sometimes precipitate acne fulminans. It normally does not affect females.
Acne fulminans is treated with corticosteroids or non-steroidal anti-inflammatory medications and isotretinoin.
Gram negative folliculitis is an inflammation of follicles caused by a bacterial infection that can result from extensive use of tetracycline or topical antibiotics. This condition may develop in people who are taking these antibiotics for severe acne.
In this condition the hair follicles are severely infected and inflamed. Pus filled pustules are seen extensively on the skin. Gram-negative folliculitis is caused by Gram negative bacteria such as Serratia marcescens, Pseudomonas aeruginosa, Escherichia coli, Klebsiella and Proteus species.
Gram-negative folliculitis is treated with isotretinoin and special antibiotics that are effective against gram-negative bacteria.
These severe, disfiguring acne conditions require extensive treatment extending for months and even years, and the patient may experience treatment failures along the course of medication. Patients will therefore need all the support and encouragement they could get from friends and family.