The patient was treated with 100 mg of isotretinoin per day for 5 months, which resulted in diminution of the condition but not complete remission. Three months later, the condition flared, and he was treated again with isotretinoin for an additional 2 months with little improvement. Colchicine treatment, 0.6 g twice daily, was begun but discontinued after 2 months because of gastrointestinal adverse effects. Modest improvement was noted. After the treatment with medications was discontinued, however, the cysts and erosions returned. Over the ensuing 6 months, the patient's condition worsened and was associated with increasing discomfort. He was treated with azathioprine, methotrexate, dapsone, ketoconazole, cephalexin, and clarithromycin for the cutaneous disease and celecoxib and gabapentin for the associated pain.