Cysts are relatively uncommon in acne; however, this form of severe acne is characterized by cysts, which may measure several centimeters in diameter as seen in these two photos:
Cysts may develop singly or be widespread as these photos show
(Photos used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides)
Cysts may occur singly, or be widespread over the face, neck, scalp, back, chest and shoulders. And, they can be painful.
The nodular cyst of acne is not a true cyst—an abnormal dilatation of a normal skin structure. Acne cysts are nodules of inflammation. The cysts may arise from a papular or nodular acne lesion, or occasionally from a type of cyst that develops in the outer layer of the skin—a type of cyst not usually associated with acne. A cyst may appear to be filled with thick, yellow pus-like fluid. This is usually an inflamed and infected cyst. If an attempt is made to drain such a cyst, it should be done in a physician’s office under sterile conditions, not in front of a bathroom mirror.
Cysts occurring close together may coalesce, producing soft areas undermined with tunnels, cell destruction and inflammation, resulting in another form of severe acne, acne conglobata.
Treatment. Nodulocystic acne usually requires an aggressive treatment regimen that may include isotretinoin and antibiotics, or intralesional corticosteroids that "melt" the cyst over a period of 3 to 5 days. Some very large follicular cysts that do not respond to medications may require drainage and surgical excision.
Gram negative folliculitis is an inflammation of follicles caused by a bacterial infection that can result from long-term antibiotic treatment. Patients who are being treated with antibiotics for severe acne may develop Gram negative folliculitis.
The word “Gram” refers to a blue stain used in laboratories to detect microscopic organisms. Certain bacteria do not stain blue and are called “Gram negative.”
Treatment. In Gram negative folliculitis, the bacteria are resistant to many antibiotics. Isotretinoin and antibiotics that are effective against Gram negative bacteria are used to treat this condition.
Anyone with severe acne should be under the care of a dermatologist as dermatologists have the experience needed to control virtually every case of acne.
It is important for patients and their families to know that severe, disfiguring forms of acne may require years of treatment and patients can experience one or more treatment failures. During treatment, the support of family and friends can greatly comfort patients. Information sources, such as AcneNet, may help family and friends to better understand what those with severe acne face every day.
Roacutan=izotretinoin [derivat vit A]