A man aged 35 years presented with multiple pustules on his face. He had undergone four months of acne treatment with minocycline 100 mg b.i.d. Although the minocycline initially decreased the number of papules and comedones, pustules soon developed that were unresponsive to the medication. A culture was taken from a pustule and treatment with trimethoprim/sulfamethoxazole (TMP/SMX)—one double-strength tablet b.i.d.—started. The culture grew out Klebsiella pneumoniae.
A woman aged 18 years presented with an eruption of facial pustules, cysts, and red papules. The lesions first appeared at the onset of puberty. The patient’s condition worsened around the time of her monthly periods. Scars developed after the pustules went away. Therapy using OTC benzoyl peroxide was ineffective. A two-month course of topical tretinoin, TMP/SMX, and norgestimate/ethinyl estradiol (Ortho Tri-Cyclen) provided only minor relief.