Acne Conglobata

Acne conglobata is a severe form of nodulocystic acne without systemic symptoms. Some patients may develop acne conglobate as part of the “Follicular Occlusion Tetrad” along with dissecting cellulitis of scalp, hidradenitis suppurativa and pilonidal sinus. Isotretinoin is used to treat acne conglobata and may require concomitant oral corticosteroids, especially at the beginning of the course when the acne can flare as isotretinoin is started. 

Acne Fulminans

Acne fulminans is a severe form of acne characterized by the abrupt onset of nodular and cystic acne lesions with systemic symptoms including fever, arthralgia and myalgia, osteolytic bone lesions and hepatosplenomegaly. This requires prompt treatment with oral corticosteroids, followed by isotretinoin, initiated at a low dose and then increased.  

Medication-induced Acne

Common medications known to cause acne include anabolic steroids, lithium, corticosteroids, unopposed progestin, and phenytoin. If the causative medication cannot be discontinued, then the acne can be treated as above. In steroid-induced acne, the lesions are quite monomorphous. In some instances, pityrosporum yeast is implicated and topical antifungals are helpful.