Nodulocystic acne is a severe form of acne affecting the face, chest and back characterised by multiple inflamed and uninflamed nodules and frequently, scars. It is more common in males. Acne conglobata is an uncommon form of nodulocystic acne in which there are interconnecting abscesses and sinuses. Nodulocystic acne may very rarely be a manifestation of a genetic disorder, PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum and Acne. Autosomal Dominant). This patient was treated with isotretinoin, but lesions recurred after few months of stoping therapy.
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I do agree that before the introduction of isotretinoin nodulocystic acne and acne conglobata were quite often refractory to treatment.For such patients ,even they are under remission I continue isotretinoin in pulse (Saturday,Sunday 20 to 40 mg)regime.