Clofazimine for Residual Nodulocystic Acne Lesions

J.M. Mascaro, H. Torras, M.C. Martinez, Department of Dermatology, Hospital Clinico, Faculty of Medicine, c/Casanova 143, Barcelona (Spain) Patients affected by nodulocystic acne treated with isotretinoin, at the correct dose and during an adequate time, may present some residual suppurative fibrocystic nodules, principally on the back of the neck. There are few therapeutic possibilities for such lesions. Local and systemic antibiotics do not help, radiotherapy gives only a transitory response and surgery, which necessitates a wide incision, leaves a very visible scar. Recently 3 patients who presented this kind of residual suppurative fibrocystic nodule on the back of the neck have been treated with clofazimine. The results were spectacular, between 1 and 3 months after completed treatment. The patients were all male, aged 27, 22 and 24 years, and had a nodulocystic acne which had been treated by isotretinoin (0.5-0.75 mg/kg/day) for 5 months. They presented recurrence of acne 1 year later needing a second isotretinoin cycle at a dose of 1 mg/ kg/day for 3 months. On completing the second treatment the acne lesions were cured, but a residual suppurative focus persisted on the back of the neck. The residual nodule of the third patient was treated by radiotherapy (Siemens Dermopan II; total dose 600 cGy, 50 kV, 25 mA, FSD 15 cm, filter 1.0 Al) with only slight improvement. The patients (weight 70 ± 5 kg) were given oral clofazimine 100 mg/ daily, two for 3 months, one for 7 months. The suppurative focus cleared. No side effects or skin pigmentation were seen. Some months after stopping clofazimine a discrete recurrence has been observed in the first and third patient, easily controlled by topical erythromycin Letters to the Editor ACA RP + ACA RP