While most people experience the brunt of acne during the difficult adolescent years, imagine the agony of living with acne well into your 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 adults. Although most people will only have to deal with transient acne, some will experience far worse. Here is a quick run-down of the most serious forms of acne.
Acne Conglobata (AC) This is a very uncommon form of acne that can produce significant disfiguration. Acne conglobata is characterized by the development of burrows in the skin, along with papules, abscesses, keloidal and atrophic facial scars. Individuals with AC 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.
Who is more susceptible to acne conglobata? In general, males are more likely to experience AC. Onset of AC usually occurs at a young age, between the ages of 18 and 30. Although no one knows the exact cause of AC, some believe it is caused by a mutation in the XXY karyotype chromosomes. A person with AC may experience extensive scarring and subsequent disfigurement. Because the effects of AC can often be dramatic, individuals afflicted with the skin disorder may be at greater risk of suffering from self-esteem issues, depression, anxiety, and they may feel stigmatized.
Acne Fulminans (AF): Acne fulminans, sometimes referred to as acne maligna, was originally thought to be acne conglobata (AC).
The major characteristics of acne fulminans include sudden onset of ulcerating acne, which may be accompanied by fever and symptoms of polyarthritis. Usually, AF 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.
What causes AF? It appears that acne fulminans is caused by a weakened immune system and 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 may also precipitate an eruption of AF.
How can you tell the difference between acne conglobata and acne fulminans? Although the physical symptoms may at first appear identical, AF is usually characterized by the presence of more physical pain. Patients with AF 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. AF 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 that is used in laboratories. This is often used 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's from the proteus and klebsiella species.
How does gram-negative folliculitis differ from regular acne vulgaris? Most cases of gram-negative folliculitis produce less papules and comedones than acne vulgaris. Treatment of gram-negative folliculitis is fortunately 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.
