Acne Conglobata Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 9, 2012
 

History

Both acne conglobata and acne fulminans (AF) can be induced by anabolic-androgenic steroid abuse.[6] Although this probably represents only a small minority of cases, one should recognize bodybuilding acne, address the substance abuse, and warn patients about other potential hazards.

Acne conglobata can be associated with hidradenitis suppurativa. Note that hidradenitis suppurativa occurs more frequently in patients with mild acne than in other patients.[7]

The list of possible associations of pyoderma gangrenosum must include acne conglobata.[8]

The association of acne conglobata and arthritis is rare, and it has been reported only in single case reports in the literature,[9, 10, 11] although musculoskeletal syndrome (ie, myalgia, arthralgia, arthritis, hyperostosis) developed in some patients with severe acne (acne conglobata and acne fulminans).[12]

Pyoderma gangrenosum, acne conglobata, and immunoglobulin A gammopathy has been observed.[13]

Renal amyloidosis may accompany acne conglobata.[14]

Acne conglobata and hidradenitis suppurativa may have a familial tendency; however, no significant relationship in the antigen patterns of patients with acne conglobata was observed.

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Physical

The draining sinus is a malevolent lesion usually seen in severe forms of acne, such as acne conglobata, acne fulminans, and acne inversa.

In patients with acne conglobata and sacroiliitis, acute anterior uveitis may occur.

The nodules associated with acne conglobata are succulent, tender, and dome shaped. Characteristic nodules increase in size; break down to discharge pus; and often fuse, forming unusual shapes of several centimeters. The formation of nodules begins in early puberty; the severity increases until late adolescence and often beyond. Active nodule formation may persist for years and usually continues until the fourth decade of life. See the image below.

A close-up view of nodules and pustules on the forA close-up view of nodules and pustules on the forehead. Courtesy of Emanuel G. Kuflik.

Isolation of coagulase-positive staphylococci is common in the lesions.

As the nodules break down, crusts may form over a deep ulcer, which extends centrifugally but tends to heal centrally. This process is persistent, and slow healing is characteristic. See the image below.

A closer view of nodules and pustules on the back.A closer view of nodules and pustules on the back. Courtesy of Emanuel G. Kuflik.

A conspicuous feature of the disease is the blackheads that appear in pairs or groups on the neck or the trunk; sometimes, blackheads involve the upper arms or the buttocks.[15]

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Causes

The primary cause of acne conglobata remains unknown.

Changes in reactivity to Propionibacterium acnes may play an important role in the etiology of the disease.

Exposure to halogenated aromatic hydrocarbons (eg, dioxins) or ingestion of halogens (eg, thyroid medication, hypnotic agents) may trigger acne conglobata in an individual who is predisposed.

Other factors that can provoke acne conglobata include androgens (eg, androgen-producing tumors) and anabolic steroids.

Acne conglobata and acne fulminans may appear after cessation of testosterone therapy or as a reaction to other medications.[16]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Ryszard Zaba, MD, PhD  Director, Department of Dermatology, Professor, Department of Dermatology and Venereology, Poznan University School of Medical Sciences, Poland

Ryszard Zaba, MD, PhD is a member of the following medical societies: European Academy of Dermatology and Venereology and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Shyam Verma  MBBS, DVD, FAAD, Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania

Shyam Verma is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Braun-Falco M, Kovnerystyy O, Lohse P, Ruzicka T. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH)-a new autoinflammatory syndrome distinct from PAPA syndrome. J Am Acad Dermatol. Mar 2012;66(3):409-15. [Medline].

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  25. Garcovich S, Amelia R, Magarelli N, Valenza V, Amerio P. Long-term treatment of severe SAPHO syndrome with adalimumab: case report and a review of the literature. Am J Clin Dermatol. Feb 1 2012;13(1):55-9. [Medline].

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Nodules on the back. Courtesy of Emanuel G. Kuflik.
Nodules on the face. Courtesy of Emanuel G. Kuflik.
A closer view of nodules and pustules on the back. Courtesy of Emanuel G. Kuflik.
A close-up view of nodules and pustules on the forehead. Courtesy of Emanuel G. Kuflik.
Nodules and pustules on the back. Courtesy of Emanuel G. Kuflik.
A close-up view of nodules and pustules on the back. Courtesy of Emanuel G. Kuflik.
 
 
 
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