Acne Vulgaris (nodulocystic type)

Diagnosis: Acne Vulgaris (nodulocystic type)

Active nodular and cystic lesions associated with numerous atrophic and hypertrophic scars on upper chest.

Clinical Presentation

Active nodular and cystic lesions associated with numerous atrophic and hypertrophic scars on upper chest.

Clinical History

Submitted by Alaa Saad. Originally posted October 16, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Rosacea • Perioral dermatitis • Folliculitis (bacterial, fungal/pityrosporum) • Demodex folliculorum infestation • Drug-induced acneiform eruption • Keratosis pilaris • Hidradenitis suppurativa

Key Learnings

• Multifactorial pathogenesis: follicular hyperkeratinization, excess sebum, C. acnes, inflammation • Isotretinoin is the only therapy that targets all four pathogenic factors • Hormonal evaluation warranted in females with treatment-resistant acne, late-onset acne, or signs of hyperandrogenism • Post-inflammatory hyperpigmentation more common and persistent in skin of color • Avoid unnecessary antibiotics — limit courses to 3-4 months and combine with benzoyl peroxide to reduce resistance

Tags: acne, vulgaris, nodulocystic, type, alaa saad