Tag Archives: best treatment very severe acne

The Best Treatment for Very Severe Nodulocystic Acne

 

Very Severe Nodulocystic Acne
Very Severe Nodulocystic Acne should be treated on an emergency footing

How to Manage Very Severe Acne

The best treatment options for very severe nodulocystic type of acne include systemic medications, surgical interventions and combined topical therapies.

Very severe acne comprises of numerous pustules, deep fluctuant nodules and cysts on the face, chest, back, and at times, on the buttocks, groin and armpits. The main concern of treating this grade 4 nodulocystic acne is prevention of scarring, which is present in more than 90% of affected individuals.

The Best Treatment for Very Severe Nodulocystic Acne

 The best medication available for very severe nodulocystic acne is oral isotretinoin. The dosage is 0.5 to 1 mg per kg body weight per day as a single dose.

As isotretinoin is teratogenic (causes birth deformities), women of child bearing age group should avoid this medication unless absolutely necessary. Pregnancy should be avoided during and two months after treatment with isotretinoin. All patients should be aware of side effects of isotretinoin and how to avoid them.

For those who would like to avoid isotretinoin, the following are the alternative choices to treat their very severe pimples:

  1. Initiate therapy with Minocycline 100 mg twice a day with topical application of either Benzoyl peroxide 5% or topical tretinoin 0.05% at night.
  2. Deep seated nodules and cysts should be drained to enhance the therapeutic effects of the antibiotics and aid the healing.
  3. Intralesional triamcinolone injection at a strength of 5mg/ml into the nodules hastens the healing process.
  4. In explosive cases of nodulocystic acne (known as pyoderma faciale), which is more common in females, a combination of oral steroids and isotretinoin works wonders in clearing the eruptive bumps at a faster rate.
  5. After 4-6 weeks, the response to treatment is reassessed. If the nodules and cysts have healed, minocycline is continued at a dose of 100 mg per day for another 4-6 weeks.
  6. If there is no recurrence and the acne bumps have healed well, minocycline may be replaced with doxycycline 100 mg daily for another one month and then tapered over a period of 2-4 months.
  7. While the oral medications are tapered, add topical clindamycin as morning applications with topical tretinoin replacing benzoyl peroxide as a maintenance therapy.
  8. If any recurrence is there, a short course of oral minocycline is repeated.
  9. If, after 4-6 weeks of minocycline, the response to treatment is not satisfactory, then the option of oral isotretinoin is explored for the patient.
Acne Conglobata
Very Severe Acne: Acne Conglobata

Females with explosive nodulocystic acne, with or without associated increased hair growth (hirsutism), should be investigated for diseases like polycystic ovarian disease.

Patients who have been treated satisfactorily should modify their life style and follow the specific tips to prevent recurrence of acne in the future.


Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Very Severe Nodulocystic Acne: FAQ

 

Frequently Asked Questions about Very Severe Acne

Sudden, very severe eruptions of nodules and cysts on the face, chest and back have to be dealt with on an emergency basis as these are potentially deep scar forming conditions.

Very Severe Nodulocystic Acne FAQ
Very Severe Nodulocystic Acne

What is Nodulocystic Acne?

Nodulocystic acne is the very severe grade 4 acne consisting of deep seated fluctuant nodules and cysts and numerous pus filled bumps. Most of the face, front of chest and back is commonly involved in nodulocystic acne.

How is Nodulocystic Acne Formed?

The basic pathogenesis of nodulocystic acne is similar to formation of other types of acne. Increased sebum secretion and inflammation caused by the bacteria P.acnes causes stretching and weakening of the wall of the sebaceous gland and hair follicle. This leads to rupture of the contents in to the dermis. A severe foreign body reaction takes place and the whole inflammatory debris and cells are segregated into fluctuant nodules and cysts deep within the dermis. Thus is formed the nodulocystic acne.

What is the Best Treatment for the Very Severe Nodulocystic Acne?

The best treatment for the very severe type of nodulocystic acne includes drainage of the pus, intralesional steroids, and oral isotretinoin. Isotretinoin gives very good results in this type of very severe acne, but its toxicity reduces its appeal to many patients. It is absolutely contraindicated in pregnancy. The second line of treatment involves use of minocycline in place of isotretinoin.

Other principles of treatment of acne also have to be observed in the case of nodulocystic acne. Avoiding acne triggers is also an important part of the management of nodulocystic acne.

What are the Complications of Very Severe Pimples?

Acne Conglobata
Very Severe Acne: Acne Conglobata result in deep scars

The nodules and cysts in the very severe type of pimples are situated deep within the dermis and when they heal, leave depressed, deep scars. Chances of hypertrophic scars are also high and in those with keloidal tendency, these will form disfiguring keloidal scars. Immediate institution of isotretinoin and other measures help reduce the severity of scarring in nodulocystic acne.

 

What are the Side Effects of Isotretinoin?

The main side effect of isotretinoin is the teratogenic effect on the fetus. Because of the risk of deformities, women should take care that they do not become pregnant during and two months after the course of isotretinoin. Most other side effects of isotretinoin in acne are related to the extreme dryness caused by the medication.

What are the Other Different Types of Very Severe Acne?

In addition to the nodulocystic acne, acne conglobata, pyoderma faciale and acne fulminans are the most severe types of pimples that are seen in patients.

What is Acne Conglobata?

Acne conglobata runs a chronic course with involved areas of the face and trunk filled with communicating cysts, abscesses and draining sinuses. The healing is with hypertrophic and atrophic scars. Recurrent episodes of joint inflammation may also be present in some patients. Treatment is similar to nodulocystic acne.

What is Pyoderma Faciale?

Pyoderma faciale commonly affects females and presents with an explosive eruption of large, tender, red cysts, mainly in the central part of the face. Spontaneous purulent discharge is present from the cysts. Comedones are conspicuous by their absence in this type of acne. Treatment is with drainage, oral isotretinoin and systemic steroids. In fact this is one of the rarer forms of acne where a short course of systemic steroids can bring fast relief to the patient.

What is Acne Fulminans?

Acne fulminans is a rare, ulcerative type of acne that mainly affects young adolescent males. There is an abrupt eruption of inflamed, necrotic acne leaving superficial and deep ulcers on the skin surface. Associated systemic symptoms of fever, weight loss, muscle and joint pains give the patient a toxic and weak appearance. Treatment is similar to pyoderma faciale.

Nodulocystic acne and other types of very severe types of acne are dermatological emergencies which need to be treated aggressively in early stages to avoid permanent deep scars.

Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD