Recalcitrant Nodular Acne

Acne is a very common skin disorder that mostly occurs among adolescents. Although the exact causes are yet to be identified, scientists believe that acne occurs because of a poorly understood combination of hormones and heredity. Acne can be of various types, and recalcitrant nodular acne, also called cystic acne, is the hardest to treat among them. Severe recalcitrant nodular acme can leave permanent scars and its most effective treatments are usually Accutane (isotretinoin) and its generic equivalents. Accutane can cure it in almost 90 percent of cases.

Recalcitrant nodular acne or cystic acne, sometimes also called nodulocystic acne, is a severe form of acne in which acne develops into small cysts. These acne cysts are in fact nodules of inflammation, and not true cysts as there are no abnormal dilations of normal skin structure. It is caused when sebum builds up in excessive amounts in the pores. Severe recalcitrant nodular acne does not respond to standard acne treatment, including oral antibiotics, and is characterized by a number of nodules or cysts.

Although many people believe so, it is neither caused nor affected by hygiene or the lack of it. If one tries to drain such a cyst, he/she should have it done in a doctor's chamber under sterile conditions, and not before a bathroom mirror. Nodular acne, of several millimeters diameter, can affect the face, chest, back, shoulders, upper arms and be painful as well. In addition to causing pain and permanent scarring, severe recalcitrant nodular acne has negative psychological effects on the affected person.

If someone develops this type of acne, the person should first try the following treatments, some of them available over-the-counter, because they pose fewer risks: benzoyl peroxide, salicylic acid, Retin-A (tretinoin), topical and oral antibiotics. Intralesional corticosteroids can also be used that "melt" the cyst within five days. Very big follicular cysts may need drainage and surgical excision.

Now a word or two about Accutane. Although it is highly effective, it poses high risks and should be used only in cases of "severe recalcitrant nodular acne," as the labeling of the product suggests. People using Accutane may develop some serious complications that can affect several organs, which includes the liver, intestines, eyes, ears, and skeletal system. It has also been observed that some Accutane users have developed serious mental disorders, including depression. In extremely rare cases, Accutane users have developed suicidal tendencies and taken their own lives.

According to a medical reviewer for Accutane in the dermatology division of the Food and Drugs Administration, people sometimes tend to dismiss the impact of acne because it's not life-threatening. But patients who have severe recalcitrant nodular or cystic acne realize all too well how much they have to suffer because of this disfiguring disease.

Since its approval by the FDA in 1982, millions of people in the United States and the whole world have been treated with Accutane, according to its makers, Hoffmann-La Roche of Nutley, N.J. The number of recalcitrant nodular acne victims taking the drug has increased, and almost half of them are women, most in their childbearing years. However, because of the risks posed by Accutane, FDA keeps evaluating the drug and work with the manufacturer to maximize its safe use.