Some patients have severe, aggressive forms of acne which merit separate  discussion. These include acne conglobata, acne fulminans, Gram-negative folliculitis, pyoderma faciale and vasculitic  acne. Notes  on their treatment are included here. Dandruff, like many dermatological symptoms, is not easy to assess clincially but it is probably more prevalent in patients with acne.

  Subjects with 'teenage' acne probably do not show an obvious  increased   incidence  of  other  androgenmediated signs such as hirsuties , irregular periods or infertility but no good study exists to demonstrate this. If correct, this  clinical supposition then supports the view that the average acne patient is not an 'endocrinological misfit'. The seborrhoea of acne thus probably represents either an altered  androgen metabolism in  the sebaceous gland or a state of end-organ hyperresponsiveness in such  patients.