Another IMPOSSIBLE case of persistent nodular cystic acne

We have a case here of a patient with one of the worst case of nodular cystic acne. The left side had a huge nodular cystic collection that has been constantly flaring up over the past year. When I first saw him, it was actually his mother that was more bothered about his face than the son himself!
Glad he was convinced to come down anyway and finally receive treatment.

 

These are the pictures when I first saw him. All pictures posted here are posted with full consent of the patient. He has gladly allowed me to share his journey on how I treat a case of severe pimples or acne vulgaris.

What we are seeing here is evidence of massive nodular cystic acne on both sides of the cheeks. Also presence of multiple papules. If he doesn't receive prompt treatment, I am worried that either the acne may develop into a cheek abscess or he will be left with terrible scaring when it finally resolves by itself. Cheek abscesses can sometimes spread to the inner cheeks as well and may result in full facial infection or cellulitis if this is left untreated.

 

The nodule on the left side was so big that it required a small incision to drain out all the pus and necrotic debris. A tiny stab incision was made after injection of local anaesthesia and this allowed the rapid drainage of the pus to be expressed.

 

The wound was packed with gauze and required alternate day dressing. This particular abscess was eventually closed with interrupted stitches. It was a difficult journey that time with every alternate day dressing, but he could come to the clinic after school for a relatively quick procedure. After the wound showed more signs of healing, it was closed with interrupted stitches and for the wound to finally heal.

 

He was subsequently put on 3 round of AGNES treatment, Q-switch laser and V-beam laser treatment. This helped to resolve most of his other stubborn acne throughout the rest of the face and also with the laser treatment to resolve the scarring and also to suppress any active acne and inflammation. This continued for the next 5 months for him, seeing him at regular intervals.

 

It is an absolutely pleasure for me to report how happy he is that he has agreed to allow me to use his pictures to document his remarkable journey. With repeated AGNES treatment for permanent control for his acne and using a unique Q-switch protocol developed by myself combined with the V-beam laser.

 The most important aspect is also the prevention of depressed scars. The ice-picks and boxscar scars are very difficult to treat and I am glad early treatment of this case of nodular cystic Acne Vulgaris has resulted in an excellent result.

Lesson to learn. Early visit to the doctor can prevent future scaring, help achieve excellent outcomes for the skin and early resolution of even the most severe cases of acne or pimples.