Severe Acne
 Forms that Can Scar and Disfigure

Severe acne can be debilitating, causing physical as well as emotional scars. Although an occasional zit is disturbing, the more serious forms can alter a person's sense of confidence and self-perception.  Acne is the skin disease that can cause a person to suffer with blemished skin consistently. The blemishes can take the form of  pimples, papules, abscesses, cysts, blackheads, whiteheads, and other painful inflammations of the skin.  Unfortunately, acne can be a whole body problem.  While most people are seriously afflicted primarily in the facial area, many people also have acne outbreaks across their back, chest, neck, and other areas of the body. 

While the teen age years are when acne is mostly seen, the agony of living with acne can continue well into the middle years.  With the stress of modern day living and increased exposure to environmental pollutants, adult acne is becoming a fact of life for many.  Although most people will only have to deal with transient acne, some will experience far worse. 

Most Severe Form of Acne

Acne Conglobata (AC)

This is a very uncommon form of acne that can produce significant scarring and disfiguration.  Acne conglobata is characterized by the development of burrows in the skin, along with papules, abscesses, keloidal and atrophic facial scars.  Individuals with this type of acne often develop blemishes that appear in clusters of two or three.  Cysts are often present that are filled with pus. Nodules may also be present, especially in the area of the back and chest.

In general, males are more likely to experience acne conglobata.  Onset usually occurs between the ages of 18 and 30.  Although no one knows the exact cause of this type of acne, some believe it is caused by a mutation in the XXY karyotype chromosomes.  A person afflicted with acne conglobata  may experience extensive scarring and subsequent disfigurement.  Because the effects of AC can often be dramatic, individuals who have this skin disorder are usually at greater risk of suffering from self-esteem problems, depression, anxiety and stigmatization

Acne Fulminans (AF).  

Acne fulminans, sometimes referred to as acne maligna, was originally thought to be acne conglobata. The major characteristics of acne fulminans include sudden onset of ulcerating acne, which may be accompanied by fever and symptoms of polyarthritis.  Usually, acne fulminans does not respond well to conventional acne treatment, such as antibacterial therapy.  The most successful treatments appear to be debridement used in conjunction with steroid therapy. 

It is believed that acne fulminans is caused by a weakened immune system together with  increased levels of testosterone and certain anabolic steroids.  These high levels of hormones cause an increase in the production and excretion of sebum and the acne-inducing bacteria known as propionibacterium acnes (P acnes).  Some skin professionals believe that isotretinoin medication may also precipitate an eruption of acne fulminans.

There is a difference between acne conglobata and acne fulminans.  Although the physical symptoms may at first appear identical, acne fulminans is usually characterized by more physical pain.  Patients with this disease may describe feelings of bone or facial pain, migraines, and fever.  Acne conglobata and acne fulminans also differ in the way they are treated.  While AC may be treated with conventional anti-acne oral and topical agents, AF typically does not respond well to such treatments.  Acne fulminans responds better to steroid treatments. 

Gram-Negative Folliculitis

Gram-negative folliculitis refers to an infection of gram-negative rods that usually occurs after an extended period of antibiotic therapy.  Scientists use the word “gram” to describe the blue stain used in laboratories to locate microscopic organisms.  The bacteria that cause gram-negative folliculitis does not stain blue, thus the term 'gram-negative.'  The most common forms of bacteria that are believed to cause gram-negative folliculitis include E. coli, serratia marcesoens, pseudomonas aeruginosa, and bacteria from the proteus and klebsiella species.

There are several differences between gram-negative folliculitis and regular acne vulgaris.  Most cases of gram-negative folliculitis produce less papules and comedones than acne vulgaris.  Gram-negative folliculitis is much easier to treat than other severe types of acne.  In most cases, conventional antibiotic therapy will help clear up gram-negative folliculitis.  Isotretinoin may also help clear up this condition.   

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