Rare forms of acne include acne fulminans, acne conglobata, and acne aestivalis. Acne fulminans is seen almost exclusively in teenage boys. It is a form of severe cystic nodular acne that heals with severe, disfiguring scarring. The cysts and nodules can easily rupture and break down, leaving multiple ulcerations. This is associated with systemic symptoms including fever, arthralgias and arthritis, and myalgias. A peripheral leukocytosis is often seen on laboratory examination. Lytic bone lesions can be seen, with the clavicle the most commonly affected bone. This may be preceded by localized pain over the bony involvement. Acne conglobata is a term used to refer to severe cystic acne, which is seen mostly in young males. Patients often have multiple cysts that can be interconnected with sinus tracts. The areas involved are very painful and heal with severe scarring. This form of acne occurs in the same locations as acne vulgaris. Acne conglobata has been seen in association with hidradenitis suppurativa, and some consider these conditions to be in the same spectrum of disease processes. Acne conglobata may run a chronic course well into adulthood, with persistent nodules and cysts coming and going. Acne aestivalis is one of the rarest forms of acne. It has a seasonal variation to its course. It begins in spring and resolves by early fall. It is a disease predominantly of adult women.
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