A Case of Rapidly Widespreaded Cystic Acne on the Face

Abstract

A 13-year-old Japanese boy had white comedones and red papules on both cheeks since January, X. In March, he visited a dermatology clinic. He was treated with oral and topical antibiotics, and topical adapalene gel, but the pustular nodules on the forehead and both cheeks expanded and worsened rapidly. He was referred to our department in May. At the time of the first visit to our department, pustular nodules were fused on the forehead, cheeks, and nose, and red papules were seen around the mouth. No skin rash was seen on the trunk. Based on the clinical findings, we diagnosed cystic acne. In addition to oral and topical antibiotics, we administered cyclosporine,Japanese-Chinese herbal medicine (Sai-rei-To and Haino-sankyu-To), pus drainage, and local injection of triamcinolone acetonide into the cyst, which suppressed the appearance of neoplastic pustules and flattened most of the pustular nodules. Cystic acne is a severe form of acne vulgaris and is considered to be a deep inflammatory rash with intense inflammation that is often difficult to treat with conventional acne therapy. In our case, immunosuppressive drugs and aggressive drainage of the deep inflammatory rash that showed strong inflammation reduced the inflammatory response. The addition of Chinese medicine inhibited the growth of new acne ; thus, it was effective in reducing the dose of immunosuppressive agents. Skin Research, 21: 91-97, 2022