Help! My Acne is Getting Worse

There are four forms of severe acne that are all VERY complicated and serious conditions that you may need to consider if your skin isn’t healing as you’d expect.

They need specialist help from a dermatologist and an extended healthcare team as soon as possible. These experts will diagnose it, do any blood tests or other investigations, and help you manage it properly to prevent severe long-term physical and mental complications.

Each of these complex forms of acne has very specific signs and symptoms, and once you recognise them, you will never forget them.

The four types of uncommon and complex acne are:

1. Acne excorie
2. Acne conglobata
3. Acne fulminans
4. Neurotic excoriation.

Acne Excorie

1. More common in females than males, especially women with adult acne
2. Excessively scratched or picked acne
3. Possible secondary infection
4. Acne may be absent and just scratch marks, sores, pigmentation, or scars be present
5. May be associated with the psychiatric condition body dysmorphic disorder (BDD)
6. May be a habit to break rather than a true medical condition.

Acne Conglobata

1. Comedones (blackheads) which are obvious and often occur in a widespread pattern on the face, neck, body, upper arms, and/or the buttocks 
2. Deep and often very painful  abscesses which are swollen areas within the skin containing an accumulation of pus
3. Inflammation (redness)
4. Severe damage to the skin
5. Scarring.

Acne Fulminans

This one is a medical emergency and can be life threatening. Seek medical assistance as fast as possible.

1. Most common in males
2. Sudden onset of severe, painful,  and often ulcerating (bleeding and crusty) acne, associated with a fever and pain  in multiple joints (polyarthritis)
3. Multiple inflammatory nodules on the body. The large nodules tend to become painful, weeping ulcers with surrounding skin death
4. Red nodules with an “overgrowth” of blood vessels may also be seen
5. Pain  in or around the bottom left of the ribs (splenomegaly) or joints (this especially affects the hips or lower back, ankles, shoulders, and knees); tender, red nodules (erythema nodosum); and sometimes bone pain
6. Tiredness, loss of appetite, and weight loss.

Neurotic Excoriation 

1. Picking at, digging, or scraping of the skin (dermatillomania), and there may be no awareness of the self-inflicted trauma as it happens and only get noticed by the resulting lesions afterwards
2. Ulceration around the nose
3. Picking continues until the skin and other bumpy material can be pulled from the skin
4. Often associated with pre-existing depression, anxiety, obsessive-compulsive disorder, body dysmorphic syndrome, eating disorders, kleptomania, or borderline personality disorder
5. Lesions on the opposite side of the face and body to the dominant hand
6. Sharp margins on the lesions, consisting of skin erosions and previous scars
7. The number of lesions and scars might vary from a few to several hundred.