Acne Conglobata Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 25, 2011
 

Medical Care

The therapy of choice for acne conglobata (AC) is isotretinoin 0.5-1 mg/kg for 4-6 months.

  • Simultaneous use of systemic steroids, such as prednisone 1 mg/kg/d for 2-4 weeks, may also prove beneficial, particularly if systemic symptoms are evident.
  • Alternatives include oral tetracycline 2 g/d or erythromycin 2 g/d, either alone or with isotretinoin or prednisone.
  • For treatment-resistant cases, dapsone 50-150 mg/d is recommended; this treatment should be carefully monitored.[18]
  • Along with vigorous medical therapy, emotional support is essential.
  • Treatment of acne conglobata with infliximab has been tried[19] ; the authors do not recommend this therapy.
  • Successful treatment of perifolliculitis capitis abscedens et suffodiens, including acne conglobata, has been described with combined isotretinoin and dapsone.[20]
  • Acne conglobata has been successfully treated by carbon dioxide laser combined with topical tretinoin therapy.[21]
  • When severe acne conglobata is unresponsive to more accepted options, modern external beam radiation may be an alternative.[22]
  • Sacroiliitis when associated (as part of the synovitis, acne, pustulosis, hyperostosis, and osteitis [SAPHO] syndrome) may benefit from the use of etanercept.[23]
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Surgical Care

  • Large hemorrhagic nodules may be aspirated.
  • Intralesional triamcinolone or cryotherapy may also be valuable.[24]
  • Occasionally, surgical excision of interconnecting large nodules may be beneficial.[25]
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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  Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University

Shyam Verma, MBBS, DVD, FAAD 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, Department of Dermatology, Geisinger Medical Center

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. Wollenberg A, Wolff H, Jansen T, Schmid MH, Rocken M, Plewig G. Acne conglobata and Klinefelter's syndrome. Br J Dermatol. Mar 1997;136(3):421-3. [Medline].

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  19. Shirakawa M, Uramoto K, Harada FA. Treatment of acne conglobata with infliximab. J Am Acad Dermatol. Aug 2006;55(2):344-6. [Medline].

  20. Bolz S, Jappe U, Hartschuh W. Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone. J Dtsch Dermatol Ges. Jan 2008;6(1):44-7. [Medline].

  21. Hasegawa T, Matsukura T, Suga Y, et al. Case of acne conglobata successfully treated by CO(2) laser combined with topical tretinoin therapy. J Dermatol. Aug 2007;34(8):583-5. [Medline].

  22. Myers JN, Mason AR, Gillespie LK, Salkey KS. Treatment of acne conglobata with modern external beam radiation. J Am Acad Dermatol. Aug 6 2009;[Medline].

  23. Wolber C, David-Jelinek K, Udvardi A, Artacker G, Volc-Platzer B, Kurz H. [Successful therapy of sacroiliitis in SAPHO syndrome by etanercept.]. Wien Med Wochenschr. Jan 25 2011;[Medline].

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  27. Hasegawa T, Matsukura T, Hirasawa Y, et al. Acne conglobata successfully treated by fractional laser after CO laser abrasion of cysts combined with topical tretinoin. J Dermatol. Feb 2009;36(2):118-9. [Medline].

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  30. Cunliffe WJ. Acne. 3rd ed. London, England: Martin Dunitz Publishers; 1993.

  31. Plewig G, Kligman AM. Acne and Rosacea. Berlin: Springer-Verlag; 1993:351-5.

 
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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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