Severe Nodulocystic Acne Research Articles

Acne Conglobata: Insights into Severe Nodulocystic Acne and Novel Therapeutic Approaches

Background: Acne Conglobata (AC) is a rare and severe form of nodulocystic acne, primarily affecting adolescents and young adults. Characterized by deep nodules, abscesses, and interconnected sinus tracts, AC often leads to significant scarring and psychological distress. Despite its rarity, it presents a unique challenge in resource-limited settings like Bangladesh, where awareness and specialized dermatological care are insufficient. The multifactorial etiology includes hormonal imbalances, genetic predisposition, and environmental factors, complicating both diagnosis and treatment. Objective: This study aims to provide comprehensive insights into the clinical characteristics, risk factors, comorbidities, and treatment outcomes of Acne Conglobata in Bangladesh, with a focus on emerging therapeutic modalities. Methods: A cross-sectional observational study was conducted at a tertiary hospital in Dhaka, Bangladesh, from January to December 2024. A total of 50 patients diagnosed with Acne Conglobata were included, with data collected through clinical evaluations, patient interviews, and medical records. Descriptive statistics were employed to analyze demographic variables, risk factors, comorbidities, and treatment outcomes. Results: The majority of patients were aged 17-30 years, with a higher prevalence in males (70%). Hormonal imbalances (especially during puberty) and a family history of acne were the most common risk factors. Comorbidities such as depression/anxiety (40%), obesity (30%), and insulin resistance (20%) were prevalent. Treatment regimens primarily involved oral isotretinoin (80%), oral antibiotics (60%), and steroids (50%). Scar revision procedures were used in 30% of cases. Conclusion: Acne Conglobata significantly impacts young adults in Bangladesh, with genetic, hormonal, and environmental factors playing key roles in its pathogenesis. Depression, obesity, and insulin resistance were common comorbidities. Oral isotretinoin remains the most effective treatment, but a multimodal approach, including psychological support and scar revision, is essential. This study highlights the need for increased awareness and access to advanced therapies, especially in resource-limited settings like Bangladesh.

Effect of oral doxycycline, azithromycin and isotretinoin on haematological inflammatory markers and interleukin-17A levels in acne vulgaris: a single blinded randomised interventional study.

Amidst the existing literature on the effect of isotretinoin on serum interleukin-17 levels in acne patients, the effects of oral antibiotics azithromycin and doxycycline on serum interleukin-17 is scarce. We conducted an investigator blinded randomized interventional study to compare the effect of doxycycline, azithromycin and isotretinoin on inflammatory markers and Interleukin-17A (IL-17A) levels in acne. Patients were randomized and received the treatment according to treatment arm till 12 weeks. At baseline and 12 weeks/treatment completion, clinical improvement and Red-cell-distribution width (RDW),Neutrophil-lymphocyte ratio(NLR),Platelet-lymphocyte ratio(PLR), Mean-Platelet volume(MPV), Platelet-distribution width(PDW) and Interleukin-17A levels were analysed. P-value < 0.05 was considered statistically significant. Out of 120 patients, 110 patients completed the study. Baseline Global acne grading scale (GAGS) in doxycycline, azithromycin or isotretinoin group was 24.32 ± 3.119, 24.12 ± 2.804 and 25.10 ± 3.985 respectively and post-treatment was 5.216 ± 1.88, 7.265 ± 2.17 and 2.769 ± 1.08. All the drugs caused a statistically significant decrease in RDW and IL-17A levels. Baseline levels of IL-17A were significantly higher in patients with higher GAGS and post-acne scarring. One of the limitations of our study was that we excluded severe nodulocystic acne patients thereby these results have to be carefully extrapolated.

The Association of CAG Polymorphism in the Androgen Receptor Gene with Nodulocystic Acne in Egyptians

Abstract Acne vulgaris is a pilosebaceous inflammatory condition with several etiologies. Hormones have a crucial role in the development of acne. Hypersensitivity of the androgen receptor gene (ARG), which is the sole receptor for androgens, was reported to share in the pathogenesis of acne. At the 5'end of exon 1 of chromosome X, ARG has a polymorphism of CAG triple loop that codes for the polyglutamine pathway. Aim of the Study The aim of this study was to investigate CAG repeat polymorphism in the ARG in Egyptian nodulocystic acne patients to clarify its relevance to the pathogenesis of nodulocystic acne. Patients and Methods Twenty-five patients with severe and very severe nodulocystic acne and 25 apparently healthy control subjects were included in the current study. Full general, dermatological assessment and acne severity determination were performed through GAGS score before genetic analysis to determine CAG repeat number in included participants. Results Genetic analysis of CAG repeats number revealed that male and female acne patients had significantly lower number of CAG repeats compared to control subjects. Moreover, after gender correction, acne patients still had significantly lower number of CAG repeats compared to control subjects. Conclusion the current study revealed that acne patients had significantly lower number of CAG repeats compared to controls.

Cannabis use and serum beta-hCG: A smoky illusion.

Systemic isotretinoin is a well-known human teratogen that remains the most effective treatment for patients &amp;gt; 12 years old with severe nodulocystic acne. This is, to our knowledge, the first report in the dermatology literature of a false-positive serum beta-human chorionic gonadotropin level from recreational cannabis use. It is important to raise awareness of this phenomenon given the ramifications of positive results for the patient, clinician and the potential workup required by various medical teams. We emphasize the importance of taking a recreational drug and alcohol history during the initial consultation and also highlight the importance of revisiting the topic in subsequent follow-up appointments.

The impact of isotretinoin on platelet and white blood cell count in patient with acne vulgaris

Background: Acne is a multifactorial disease and represents a spectrum of disease severity from a couple of blackheads and pustules to severe nodulocystic fulminant acne. The severity of the disease differs from patient to patient therefore Isotretinoin is a commonly used for treating acne. However, isotretinoin may lead to elevated serum levels of triglycerides and cholesterol, and it may affect liver function tests. Moreover, the effect of isotretinoin on hematological parameters remains controversial and examines changes in the blood chemistry panel, hematological parameters of patients diagnosed with acne and treated with isotretinoin. Methods: This comparative clinical trial carried out at Clinic in the Department of Dermatology in tow hospitals Salahaddin hospital and emergency hospital in Salahaddin city in Iraq. 116 patients were selected. Patients are suffering from acne and divided equally (58 patients each) to one of the two treatment regimens using isotretinoin and doxycycline. Group one was given oral isotretinoin twice daily for seven months and Group two was given doxycycline twice daily for same period. These patients were prepared before the time of study and were followed up during the treatment period. According to female, pregnancy prevented by two contraceptive methods. Both groups are investigated with the same investigations. Results: Among the 116 cases included in the study, (36) were male and (80) were female. The mean age of group one was 21.97±4.87 years and in group two was 21.72±4.95years Mean, platelet count increased, whereas white blood cell count decreased after isotretinoin treatment. But without any statically significant association. Conclusions: The results of this study revealed that no statically significant effect of white blood cells and platelets count after therapy by isotretinoin. Keywords: Acne, Isotretinoin, white blood cells and platelets. Aim of study The aim of this study was to assess and compare the efficacy of oral isotretinoin on WBC and platelet count in acne vulgaris patients.

Protocolo diagnóstico y tratamiento del acné en adolescentes

Acne is a chronic inflammatory disease of the pilosebaceous unit that predominantly affects the facial region. It can alter the patient's quality of life to a great extent. It is one of the most common dermatological diseases and is responsible for a significant number of medical consultations. Acne is classified as comedonal, mild or moderate papulopustular, severe papulopustular, moderate nodular, or severe nodulocystic acne or acne with a tendency toward scarring. Treatments are available which can control its symptoms and long-term effects. This work discusses useful diagnostic and treatment protocols for the proper management of the disease by the physician.

Athena Speciality Certificate Examination case for formulation and systemic therapy.

A 25-year-old man with severe nodulocystic acne vulgaris is reviewed in clinic to start on isotretinoin. He has a background of asthma and peanut allergy. He recently consumed soy-containing food with no allergic reactions. His liver function, renal function and lipids levels are within normal range.

Dermatologists' Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt.

AimThe FDA approved isotretinoin for moderate and severe nodulo-cystic acne, in which it proved effective. However, this misled the dermatologists into using isotretinoin for mild cases as well. This misuse increased the risk of developing adverse effects, especially on the ocular system. These adverse effects vary from mild reversible eye dryness to severe irreversible loss of night vision. Also, it causes contact lens intolerance and corneal ulcer on top. Both ophthalmologists and dermatologists have different perceptions of the drug.PurposeTo evaluate dermatologists’ knowledge and attitude toward ocular adverse effects of isotretinoin in Egypt.MethodsThis cross-sectional study was conducted via an online questionnaire. The questionnaire had three parts: 1) demographic data, 2) knowledge about isotretinoin dry eye disorders, contact lens intolerance, and refractive surgery precautions and 3) dermatologists’ management of a case on isotretinoin therapy. We contacted 111 participants from Facebook dermatologists’ groups between March and April 2021.ResultsWe surveyed 111 dermatologists. One hundred and five (94.6%) reported their knowledge about ocular side effects. One hundred of them (90.1%) informed their patients about the drug’s adverse effects. Eighty-three (74.8%) reported their knowledge about contact lens intolerance. Forty-one dermatologists (36.9%) screened their patients for recent refractive surgery before isotretinoin therapy. Nearly, all dermatologists routinely prescribed lubricant eye drops for the patients, and 63 (56.8%) dermatologists sometimes referred their patients to an ophthalmologist. We found an association between knowledge about contact lens intolerance and years of experience (p=0.012). As well, we found that the academic degree of dermatologists is directly proportional with warning patients about ocular side effects (p=0.003) and refractive surgery (p=0.039).ConclusionEgyptian dermatologists were knowledgeable about the effects of isotretinoin on eyes with inappropriate clinical practice.

Isotretinoin Hepatotoxicity or Isotretinoin Induced Autoimmune Hepatitis?

While isotretinoin, a drug used for the treatment of severe nodulocystic acne, is known to be hepatotoxic, an association with autoimmune hepatitis (AIH) has not been suggested so far. A 17-year-old girl diagnosed with AIH following isotretinoin use for acne vulgaris is presented, and the differences between isotretinoin hepatotoxicity and isotretinoin triggered AIH were discussed. To conclude this case, we want to underline that induction of an AIH by isotretinoin, even though so far unreported, is possible and thus the drug should be used with care, especially in patients with another autoimmune disease.

17980 Severe nodulocystic acne in a renal dialysis patient managed successfully with low-dose isotretinoin

A 31-year-old woman with a background of a previous simultaneous pancreas-kidney (SPK) transplant with failed kidney, on long-term dialysis, was referred to our dermatology service for management of severe nodulocystic acne. She had type 1 diabetes, with secondary retinopathy, nephropathy and gastroparesis. Examination revealed severe nodulocystic acne affecting her face and neck, with evidence of scarring. Previous treatments included conventional topical treatments, as well as oral oxytetracycline. Her regular medications were mycophenolate mofetil, prednisolone, isoniazid, and paroxetine. Six months of low dose isotretinoin treatment (20 mg daily) resulted in complete resolution of her acne and there have been no adverse side effects reported thus far. Nodulocystic acne is not uncommon in renal dialysis patients. The mechanism of this whilst still largely unknown, has previously been postulated to be related to the toxic effect of uraemia. Nodulocystic acne often has a significantly negative impact on a patient’s quality of life and often fails to respond to conventional acne therapy. The use of low dose isotretinoin to treat acne in haemodialysis patients has been scarcely reported with only Lin et al’s prospective study in 1999 showing significant efficacy and minimal side effects. Renal elimination of isotretinoin and its metabolites is known to be negligible, and isotretinoin is protected from haemodialysis removal through its protein binding. Our case adds to the evidence that low-dose isotretinoin can safely and successfully be used to treat severe nodulocystic acne in renal dialysis patients, leading to a significant improvement in patients’ quality of life.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated.&#x0D; Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks.&#x0D; Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile.&#x0D; Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

CAN LOW DOSE OF ISOTRETINOIN CAUSE DEPRESSION

Background: Depressive symptoms may associate with the daily recommended dose of Isotretinoin for nodulocystic acne. Does reduce the dose will reduce the incidence of depressive symptoms is still not clearly understood. Study objective: To compare the types and frequency of depressive symptoms among patients with nodulocystic acne receiving three different low doses of isotretinoin (10mg daily, 20mg every other day, and 20mg daily). Study design: Open randomized clinical trial. Study setting: Dermatology clinic at Ibn Sina teaching hospital Patients & methods: 169 patients with severe nodulocystic acne were randomly assigned to one of three isotretinoin regimen groups as follows: 10 mg daily (n=46), 20mg alternate day (n=58), and 20 mg daily (n=65). After a month of treatment, the patient assessed for degree of improvement of acne and incidence of depressive symptoms Results: The frequencies of depressive symptoms irrespective to the group were as follows: crying in 36 (21.3%), anger in 35 (20.7%), sleep disturbance in 32 (18.9%), isolation in 29 (17.1%), and sadness in 20 (11.8%) of patients. The frequency of crying, anger, and sadness was significantly rose with an increased dose of isotretinoin from 10mg to 20mg daily (p-value equal to 0.02, 0.02, and 0.001 respectively). The summated depressive symptoms rose from (0.52 symptoms) in 10 mg daily to (1.19 symptoms) in 20 mg daily dose and the difference was statistically significant. Conclusion: Depressive symptoms increased gradually with an increased dose of isotretinoin and reducing the dose to the least effective dose is mandatory. Key Words: isotretinoin, dose regimen, depression, nodulocystic acne.

Sistemik İzotretinoin Tedavisinin Oküler Yüzey ve Kornea Epitel Kalınlığı Üzerine Etkisi

Objective:To evaluate the effect of systemic isotretinoin treatment on central corneal epithelial (CET), tear film corneal epithelial thickness(TCET) and mean central corneal thickness (CCT) measured by anterior segment optical coherence tomography (AS-OCT). Material and Methods: Patients who had severe nodulocystic acne disease and evaluated in our clinic prior to oral 0.5-1 mg/kg/day isotretinoin treatment were recruited. Ocular surface changes were evaluated by tear film break-up time (BUT) and Schirmer tests and ocular complaints were scored by Ocular Surface Disease Index (OSDI) questionnaire. Mean central CET, TCET and mean CCT were measured by using AS-OCT. These detailed examinations and measurements were performed prior to systemic isotretinoin intake and on the following first, third and sixth months of treatment. These data were compared statistically to find out the changes with this treatment. Results: Sixty four eyes of 17 female and 15 male patients were recruited. The mean age of the patients was 17.5±2.3 years. The mean CCT decreased gradually in three months (p=0.001). The mean TCET was not affected during treatment (p=0.154).The mean CET increased on the first month and decreased on the third month and increased again on the sixth month of the treatment (p=0.041, p=0.010, p=0.006). Tear film BUT decreased gradually in six months (p<0.001).The change in Schirmer test was not statistically significant (p=0.079).The OSDI scores gradually increased (p<0.001). Conclusion: Mean central CET and CCT measured by AS-OCT were found to be affected in the early period of oral isotretinoin treatment.

Isotretinoin induced nail fold pyogenic granuloma resolution with combination therapy: A case report and review of the literature

Pyogenic granulomas are vascular hyperplasias presenting as red papules, polyps, or nodules on the gingiva, fingers, lips, face and tongue of children and young adults. Most commonly they are associated with trauma, but systemic retinoids have rarely been implicated as a causative factor in their appearance. We present a case of spontaneous eruption of multiple pyogenic granulomas of the bilateral periungal fingers in an otherwise healthy adolescent male undergoing isotretinoin therapy for severe nodulocystic acne. These pyogenic granulomas did not resolve spontaneously with discontinuation of isotretinoin, or first line therapeutic modalities. Their resolution did occur with administration of intralesional steroids and ablation with silver nitrate.

The adjunctive effect of desloratadine on the combined azithromycin and isotretinoin in the treatment of severe acne: Randomized clinical trial

Background: Desloratadine, when combined with isotretinoin, had a favorable effect in the treatment of moderate acne; however, its effect in severe nodulocystic acne remained to be elucidated. Aim of the Study: The aim of the study was to evaluate the effect of adding oral desloratadine to the combined azithromycin and isotretinoin regimen for severe acne. Patients and Methods: Patients were randomly classified into two groups: 1st (control) included 38 patients and received alternating isotretinoin and azithromycin orally and 2nd (intervention) group included 38 patients and received same regimen plus desloratadine 5 mg/day. Assessment was made at baseline, 4, 8, and 12 weeks of the trial. Results: In both groups, there was statistically significant reduction in count of inflammatory lesions at 12 weeks compared to baseline (59 ± 19–9 ± 7 for 2nd group and from 57 ± 18 to 21 ± 8 for control) (P 80%). Conclusion: Oral desloratadine had antiacne properties, and when combined with azithromycin plus isotretinoin protocol, it significantly improves severe acne lesions and minimizes the adverse drug reactions.

Efficacy and Safety of Combined Isotretinoin and Azithromycin for Treatment of Severe Nodulocystic Acne

Efficacy and Safety of Combined Isotretinoin and Azithromycin for Treatment of Severe Nodulocystic Acne

Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis.

Isotretinoin is a treatment option for severe nodulocystic acne. However, its use has inconsistently been associated with the development of inflammatory bowel disease (IBD). This meta-analysis aims to elucidate the association between isotretinoin exposure and the risk for IBD. A comprehensive search of PubMed/MEDLINE, CINAHL, the Cochrane database, and Google Scholar was performed (July 2015). All studies on the development of IBD in patients with or without prior exposure to isotretinoin, along with control participants, were included. Meta-analysis was carried out using the Mantel-Haenszel random effect model to assess the risk for IBD in the context of prior isotretinoin exposure. In a pooled analysis of six research studies, there was no increased risk of developing IBD in patients exposed to isotretinoin compared with patients not exposed to isotretinoin [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.82, 1.42, P=0.59]. Furthermore, there was no increased risk of developing Crohn's disease (OR 0.98, 95% CI 0.62, 1.55, P=0.93, I(2)=62%) or ulcerative colitis (OR 1.14, 95% CI 0.79, 1.63, P=0.49, I(2)=44%) in patients exposed to isotretinoin compared with those not exposed to the medication. Isotretinoin exposure is not associated with an increased risk of developing both ulcerative colitis and Crohn's disease.

Comprehensive Multiplexed Therapy for Severe Nodulocystic Acne in Puberty

Nodulocystic acne (NCA) usually develops subcutaneous epidermal cyst, granuloma, subcutaneous abscess, hypertrophic scar, keloids, and draining sinus. The pathogenesis of NCA is still unclear. Similar to NCA, acne conglobata (AC) is found in men predominantly with oily skin [1]. Lesions of AC begin in early puberty and culminate in late adolescent [1]. AC is one of the most therapy-resistant diseases which do not respond to usual treatments for acne vulgaris. In Europe and USA, isotretinoin has been used for the treatment for NCA and AC [2]. However, it is unavailable to use in Japan. Therefore, treatment for NCA in Japan is very difficult. Two cases with NCA have been treated with comprehensive therapy with incision, oral and topical antimicrobials, oral tranilast, topical benzoyl peroxide (BPO) and skin care.

Association of dry eye syndrome with oral Isotretinoin therapy for severe nodulocystic acne and recalcitrant acne vulgaris

Introduction: Oral isotretinoin was registered in Nepal almost three decades later its first introduction in USA. It remains the most clinically effective medication for acne. Dry eye syndrome is a ‘certain’ adverse effect of oral isotretinoin therapy which can be validated by tear film break up time and Schirmer I tests.Methods: Fifty patients aged above 12 years presenting to dermatology outpatient department of Dhulikhel Hospital with severe nodulocystic acne or recalcitrant acne vulgaris not responding to three months of systemic antibiotics along with topical agents were included. Tear film break up time and Schirmer I tests before, at 45 and 90 days, and one month after taking oral isotretinoin were performed to study association of dry eye syndrome due to oral isotretinoin.Results: Both eyes of fifty selected patients were sampled. Baseline mean tear film break up time of 12.37±4.17 sec decreased to 9.69±3.70 sec, 9.09±3.77 sec and 10.67±3.50 sec at 45 and 90 days and on follow up, respectively. Likewise, baseline mean Schirmer I value of 16.68±8.73 mm decreased to 12.26±7.64 mm, 11.49±8.07 mm and 11.76±8.11 mm respectively at 45 and 90 days and on follow up. The differences between the mean values were analyzed using paired samples T test and all were statistically significant except between the mean Schirmer values at 90 days and on follow up.Conclusions: Abnormal mean tear break up time at 45 and 90 days in this study suggests that dry eye syndrome was caused by oral isotretinoin during acne therapy but tends to revert to normal on cessation.Journal of Patan Academy of Health Sciences, Vol. 2, No. 1, 2015. page:12-16

Costello syndrome with severe nodulocystic acne: unexpected significant improvement of acanthosis nigricans after oral isotretinoin treatment.

We report the case of 17-year-old female diagnosed with Costello syndrome. Genetic testing provided a proof with G12S mutation in the HRAS gene since 3 years of age with a presentation of severe nodulocystic acne on her face. After 2 months of oral isotretinoin treatment, improvement in her acne was observed. Interestingly, an unexpected significant improvement of acanthosis nigricans on her neck and dorsum of her hands was found as well. We present this case as a successful treatment option by using oral isotretinoin for the treatment of acanthosis nigricans in Costello syndrome patients.