Severe acne can make a person's life truly miserable. People suffering from it may limit their own social lives due to embarrassment and stress. It can hamper romantic intent and work opportunities. It may be disfiguring and need years of careful treatment - and for those reasons, it is best to be referred to a dermatologist who has in depth knowledge and experience of the condition.

WHAT IS ACNE CONGLOBATA?

Ordinary 'teenage spots' (acne vulgaris) are extremely common and blight the life of virtually every adolescent at one time or another. Acne conglobata is rare and is a much more severe form. It usually appears between the ages of 18 and 30 but it sadly leaves scars for life - physical, mental and emotional. It affects more males than females and can even strike babies.

The primary cause of acne conglobata is unknown although some things are recognized as triggers. Toxic gases like dioxins or halogens and anabolic steroids can induce severe acne in susceptible individuals. Stopping a course of testosterone can also cause it. It can develop as a result of the deterioration in an existing pustular acne or may arise from a previous acne which has lain dormant for many years.

WHAT DOES ACNE CONGLOBATA LOOK LIKE?

The acne lesions (comedones) of this usually occur on the face, neck, chest, upper arms and buttocks. They often occur in clumps of 2 or 3. Inflamed nodules form around these clumps of comedones. A nodule is an inflamed lesion of more than 5mm across. They get bigger until they finally break down and discharge foul-smelling pus that returns once the nodule has drained. Deep ulcers may form under these nodules and may track under the skin to join up with others. Abcesses can leave deep, irregularly shaped scars.

WHAT TREATMENT IS AVAILABLE?

The main treatment is called isotretinoin. This is a derivative of vitamin A and is made under the brand name of Accutane. Doctors will only prescribe it for anyone with severe nodula acne that has not responded to any other treatments. It is a pill taken orally for a course of 15-20 weeks. A single course has been shown to completely clear acne and give long-term remission to many people.

It works by reducing the amount of oil produced by the sebaceous glands and because of this, Accutane has many side effects. These include dry and cracked lips, dry skin, a dry nose and mouth and mild to moderate aches in the joints or muscles.

iPLEDGE

However, the main side effect is potentially devastating. There is an extremely high risk that if pregnancy occurs while the person is taking Accutane (in any amount and even for a short time) that a miscarriage or a deformed baby can result. For that reason, a special programme called iPLEDGE has been set up in America. Patients can only get Accutane if they are registered with iPLEDGE and if their prescribing doctor and pharmacy are both registered.