Dermatologists and patients alike face a difficult challenge when dealing with severe, stubborn nodular acne. The deep, painful, and massive nodules that define this aggressive form of acne can cause long-lasting mental and physical scars. Because of its resistance to topical medications, therapy necessitates a comprehensive approach that frequently involves systemic therapies. In addition to their physical agony, patients with severe recalcitrant nodular acne frequently endure significant psychological anxiety. Depression and social disengagement can result from the significant effects on one's sense of self-worth and standard of living. Thus, it is imperative to receive timely and efficient therapy in order to both reduce symptoms and enhance the patient's general health. In order to address the underlying causes of extremely severe acne, dermatologists usually start treatment with a mix of oral drugs. Since oral isotretinoin can decrease sebum production, restore follicular keratinization, and have anti-inflammatory properties, it is the recommended treatment for severe nodular acne. However, because of the possibility of side effects such teratogenicity, dry skin, and mucosal dryness, its use needs to be closely monitored. Oral antibiotics like doxycycline or minocycline are frequently recommended in combination to isotretinoin to lessen inflammation and regulate bacterial growth within the hair follicles. In this case, the anti-inflammatory qualities of these medicines are more important than their antibacterial ones. Hormonal treatments, such as oral contraceptives or anti-androgen drugs, may be suggested for female patients with severe, resistant nodular acne. The goal of these treatments is to balance out hormonal abnormalities that lead to acne, especially when high levels of androgen activity are suspected. For the treatment of severe nodular acne, systemic medicines are essential, but adjuvant therapy are also possible. By decreasing inflammation, intralesional corticosteroid injections can offer quick relief from uncomfortable nodules. Particularly sensitive or persistent localized lesions benefit greatly from these injections. Dermatologists also stress the value of a regular skincare routine designed specifically for skin that is prone to acne. To keep skin healthy and reduce irritation, use sunscreen, non-comedogenic moisturizers, and gentle cleansers. In the end, treating severely resistant nodular acne necessitates a customized, multimodal strategy for each patient. To achieve long-term control of this difficult illness, dermatologists must closely monitor the patient and provide education and support.
