I think about my patients with acne fulminans often, because often they suffer pain on the skin with their systemic symptoms, and it can take months of regular visits with dermatologists until they start to improve. Sometimes even multiple courses of isotretinoin are not enough to get their disease under control, and we have to move to heavy-duty anti-inflammatory medications.
Though acne is one of the most common problems that we treat in dermatology, there are many different types of acne. A few pimples may be bothersome to most patients, but on the other end of the spectrum are conditions like acne conglobata and acne fulminans, which can cause extreme and permanent scarring, disfigurement, and psychological hardship. The treatment for each type of acne is different and requires tailoring to different patients depending on their age, sex and tolerance for different medications.
Isotretinoin is a great option for severe acne, but patients have to be aware of and accept the side effects for successful treatment. Though anabolic steroids can propagate acne fulminans and conglobata, nonanabolic steroids can be used early in the treatment of severe acne. Antibiotics and spironolactone in conjunction with topical medications are appropriate for mild to moderate cases. Partner with your dermatologist for successful treatment of your acne!