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The Best Treatment for Nodulocystic Acne

How to Manage Very Severe Pimples

Nov 11, 2009 Hanish Babu

The best treatment options for very severe nodulocystic type of acne include systemic medications, surgical interventions and combined topical therapies.

Very severe acne comprises of numerous pustules, deep fluctuant nodules and cysts on the face, chest, back, and at times, on the buttocks, groin and armpits. The main goal of treating this grade 4 nodulocystic acne or acne conglobata is prevention of scarring, which is present in more than 90% of affected individuals.

The Best Treatment for Very Severe Nodulocystic Acne

The best medication available for very severe nodulocystic acne is oral isotretinoin. The dosage is 0.5 to 1 mg per kg body weight per day as a single dose.

As isotretinoin is teratogenic (causes birth deformities), women of child bearing age group should avoid this medication unless absolutely necessary. Pregnancy should be avoided during and two months after treatment with isotretinoin. All patients should be aware of side effects of isotretinoin and how to avoid them.

For those who would like to avoid isotretinoin or who cannot use it, the following are the alternative choices to treat their very severe pimples:

  1. Initiate therapy with Minocycline 100 mg twice a day with topical application of either Benzoyl peroxide 5% or topical tretinoin 0.05% at night.
  2. Deep seated nodules and cysts should be drained to enhance the therapeutic effects of the antibiotics and aid the healing.
  3. Intralesional triamcinolone injection at a strength of 5mg/ml into the nodules hastens the healing process.
  4. In explosive cases of nodulocystic acne (known as pyoderma faciale), which is more common in females, a combination of oral steroids and isotretinoin works wonders in clearing the eruptive bumps at a faster rate.
  5. After four to six weeks, the response to treatment is reassessed. If the nodules and cysts have healed, minocycline is continued at a dose of 100 mg per day for another four to six weeks.
  6. If there is no recurrence and the acne bumps have healed well, minocycline may be replaced with doxycycline 100 mg daily for another one month and then tapered over a period of two to four months.
  7. While the oral medications are tapered, add topical clindamycin as morning applications with topical tretinoin replacing benzoyl peroxide as a maintenance therapy.
  8. If any recurrence is there, a short course of oral minocycline is repeated.
  9. If, after four to six weeks of minocycline, the response to treatment is not satisfactory, then the option of oral isotretinoin is explored for the patient.

Females with explosive nodulocystic acne, with or without associated increased hair growth (hirsutism), should be investigated for diseases like polycystic ovarian disease.

Patients who have been treated satisfactorily should modify their life style and follow the specific tips to prevent recurrence of acne in the future.

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Disclaimer

The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, Dr.Hanish Babu, MD or Suite101 will not be responsible for any consequences. The images provided are for illustration purposes only.

The copyright of the article The Best Treatment for Nodulocystic Acne in General Medicine is owned by Hanish Babu. Permission to republish The Best Treatment for Nodulocystic Acne in print or online must be granted by the author in writing.
What is the Best Treatment for Very Severe Acne?, Dr.Hanish Babu, MD What is the Best Treatment for Very Severe Acne?
Treat Nodulocystic Acne Early to Avoid Scarring., Dr.Hanish Babu, MD Treat Nodulocystic Acne Early to Avoid Scarring.
Very Severe Acne: Isotretinoin Best Medication., Dr.Hanish Babu, MD Very Severe Acne: Isotretinoin Best Medication.
Acne Conglobata: Healing with Oral Retinoids., Dr.Hanish Babu, MD Acne Conglobata: Healing with Oral Retinoids.
Draining Cysts: Hasten Healing of Acne., Dr.Hanish Babu, MD Draining Cysts: Hasten Healing of Acne.
 
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