Comprehensive Multiplexed Therapy for Severe Nodulocystic Acne in Puberty

Nodulocystic acne (NCA) usually develops subcutaneous epidermal cyst, granuloma, subcutaneous abscess, hypertrophic scar, keloids, and draining sinus. The pathogenesis of NCA is still unclear. Similar to NCA, acne conglobata (AC) is found in men predominantly with oily skin Lesions of AC begin in early puberty and culminate in late adolescent AC is one of the most therapy-resistant diseases which do not respond to usual treatments for acne vulgaris. In Europe and USA, isotretinoin has been used for the treatment for NCA and AC However, it is unavailable to use in Japan. Therefore, treatment for NCA in Japan is very difficult. Two cases with NCA have been treated with comprehensive therapy with incision, oral and topical antimicrobials, oral tranilast, topical benzoyl peroxide (BPO) and skin care.