Abstract
Acne is the most common of skin diseases, being characterized as a chronic inflammatory
disease of the pilosebaceous unit. Although acne is usually straightforward to diagnose
and treat, some patients have difficult or rare forms of acne. What seems to be “nonresponding
acne” in a patient may be caused by another acneiform disease that clinically mimics
acne, thus misleading the clinician, if not ruled out, with scrutiny. Difficulties
in the management of acne may be attributable to patient-related issues (low adherence
to treatment or fear for side effects), treatment-related issues (inappropriate treatment,
dose, or duration of treatment), or difficult-to-treat acne types (acne conglobata
or acne fulminans). Rare forms of acne may be present in the context of complex syndromes,
such as the synovitis, acne, pustulosis, hyperostosis, osteitis syndrome; pyogenic
arthritis, pyoderma gangrenosum, acne syndrome; pyoderma gangrenosum, acne, and suppurative
hidradenitis syndrome; or congenital adrenal hyperplasia, in association with other
systemic findings, often with a positive family history.
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