Acne conglobata

Acne conglobata
Acne conglobata
Specialty	Dermatology

Acne conglobata is a highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts.^[1]^[2]

This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. Although the cause of this type of acne is unknown, it is associated with testosterone and thus appears mainly in males. It can be caused by anabolic steroid abuse and sometimes appears in males after stopping testosterone therapy. It can also happen to someone who has a tumor that is releasing large amounts of androgens, or to people in remission from diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens.^[3]

Presentation

Acne conglobata is a severe, inflammatory variant of acne. Inflammatory papules, papulonodules, nodules and pustules may coalesce, and abscesses in the skin may form sinuses that interconnect.^[4] Bleeding or draining of acneiform plaques may be present. The systemic findings seen in acne fulminans are not present. A component of the follicular occlusion tetrad, acne conglobata may be seen with hidradenitis suppurativa, pilonidal disease and dissecting cellulitis of the scalp.^[5] The face, chest, back and buttocks may be involved.^[6]

Treatment

The most common treatment is the acne medication isotretinoin. It may be combined with prednisone. Antibiotics such as dapsone, tetracycline or erythromycin may also be prescribed. An option to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy has been described.^[7]

Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with corticosteroids such as triamcinolone.^[8]

References

^ Freedberg, Irwin M.; Eisen, Arthur Z.; Wolff, Klaus; Austen, K. Frank; Goldsmith, Lowell A.; Katz, Stephen I., eds. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill. p. 685. ISBN 0-07-138076-0.
^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 449. ISBN 978-1-4160-2999-1.
^ Acne Conglobata at eMedicine
^ Hafsi W, Badri T (2023). Acne Conglobata in StatPearls. PMID 29083736.
^ Vasanth V, Chandrashekar BS (October 2014). "Follicular occlusion tetrad". Indian Dermatol Online J. 5 (4): 491–3. doi:10.4103/2229-5178.142517. PMC 4228650. PMID 25396138.
^ Shirakawa M, Uramoto K, Harada FA (August 2006). "Treatment of acne conglobata with infliximab". J. Am. Acad. Dermatol. 55 (2): 344–6. doi:10.1016/j.jaad.2005.06.008. PMID 16844527.
^ Hasegawa T, Matsukura T, Suga Y, Muramatsu S, Mizuno Y, Tsuchihashi H, Haruna K, Ogawa H, Ikeda S (2007). "Case of acne conglobata successfully treated by CO(2) laser combined with topical tretinoin therapy". primary source. J. Dermatol. 34 (8): 583–5. doi:10.1111/j.1346-8138.2007.00337.x. PMID 17683393.
^ Acne Conglobata~treatment at eMedicine