Acne Conglobata Treatment & Management

Updated: Apr 23, 2018
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

The therapy of choice for acne conglobata (AC) includes 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, minocycline, or doxycycline. Oral tetracycline antibiotics should not be combined with oral isotretinoin because of an increased risk of pseudotumor cerebri.

For treatment-resistant cases, dapsone 50-150 mg/d is recommended; this treatment should be carefully monitored. [27]

Along with vigorous medical therapy, emotional support is essential.

Treatment of acne conglobata with infliximab has been reported. [28]

Successful treatment of perifolliculitis capitis abscedens et suffodiens, including acne conglobata, has been described with combined isotretinoin and dapsone. [29]

Acne conglobata has been successfully treated by carbon dioxide laser combined with topical tretinoin therapy. [30]

When severe acne conglobata is unresponsive to more accepted options, modern external beam radiation may be an alternative. [31]

The triad of pyoderma gangrenosum, acne, and suppurative hidradenitis, the so-called PASH syndrome, may respond to interleukin 1-beta blockade. [2]

Patients with SAPHO syndrome may benefit from the use of etanercept. [32] or combination treatment with isotretinoin and adalimumab, an antitumor necrosis factor-alpha monoclonal antibody. [33] Another option may be infliximab infusion. [3]

In December 2014, the US Food and Drug Administration (FDA) approved Bellafill, the first dermal filler indicated for acne scarring. Bellafill is a bovine collagen dermal filler.

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Surgical Care

Large hemorrhagic nodules may be aspirated.

Intralesional triamcinolone or cryotherapy may also be valuable. [34]

Occasionally, surgical excision of interconnecting large nodules may be beneficial. [35]

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Consultations

Failure to recognize and treat acne conglobata (AC) can produce considerable disfigurement. Suicidal ideation, a concern in seemingly healthy adolescents, should be anticipated in those with cosmetically disturbing skin disorders, especially in adolescent males with acne conglobata. [36] It may be wise to order routine screening for psychological disturbance in adolescents with acne conglobata. Use of isotretinoin is not contraindicated in those with depression. [37]

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