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.^[31]

Along with vigorous medical therapy, emotional support is essential.

Treatment of acne conglobata with infliximab has been reported.^[32]

Successful treatment of perifolliculitis capitis abscedens et suffodiens, including acne conglobata, has been described with combined isotretinoin and dapsone.^[33]

Acne conglobata has been successfully treated by carbon dioxide laser combined with topical tretinoin therapy.^[34]

When severe acne conglobata is unresponsive to more accepted options, modern external beam radiation may be an alternative.^[35]

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.^[36]or combination treatment with isotretinoin and adalimumab, an antitumor necrosis factor-alpha monoclonal antibody.^[37]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.

Surgical Care

Large hemorrhagic nodules may be aspirated.

Intralesional triamcinolone or cryotherapy may also be valuable.^[38]

Occasionally, surgical excision of interconnecting large nodules may be beneficial.^[39]

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.^[40]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.^[41]

Guidelines

Patterson WM, Stibich AS, Dobke M, Schwartz RA. Mutilating facial acne conglobata. Cutis. 2000 Aug. 66(2):139-40. [QxMD MEDLINE Link].
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. 2012 Mar. 66(3):409-15. [QxMD MEDLINE Link].
Bruzzese V. Pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis: efficacy of anti-tumor necrosis factor a therapy. J Clin Rheumatol. 2012 Dec. 18(8):413-5. [QxMD MEDLINE Link].
Lacarrubba M, Micali G. Secondary Comedones in a Case of Acne Conglobata Correlate with Double-ended Pseudocomedones in Hidradenitis Suppurativa. Acta Derm Venereol. 2017 Mar 30. [QxMD MEDLINE Link].
Hallock KK, Mizerak MR, Dempsey A, Maczuga S, Kirby JS. Differences Between Children and Adults With Hidradenitis Suppurativa. JAMA Dermatol. 2021 Sep 1. 157 (9):1095-1101. [QxMD MEDLINE Link].
Zuo RC, Schwartz DM, Lee CC, Anadkat MJ, Cowen EW, Naik HB. Palmoplantar pustules and osteoarticular pain in a 42-year-old woman. J Am Acad Dermatol. 2015 Mar. 72(3):550-3. [QxMD MEDLINE Link]. [Full Text].
Fremlin GA, Wernham AGH, Patel A, Orpin S. Acne conglobata and necrotizing scleritis: a previously unreported association. Clin Exp Dermatol. 2019 Jan 17. [QxMD MEDLINE Link].
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Schackert K, Scholz S, Steinbauer-Rosenthal I, Albert ED, Wank R, Plewig G. Letter: HL-A antigens in acne conglobata: a negative study. Arch Dermatol. 1974 Sep. 110(3):468. [QxMD MEDLINE Link].
Yeon HB, Lindor NM, Seidman JG, Seidman CE. Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome maps to chromosome 15q. Am J Hum Genet. 2000 Apr. 66(4):1443-8. [QxMD MEDLINE Link].
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Benhadou F, Villani AP, Guillem P. Which Factors Determine Affected Sites in Hidradenitis Suppurativa?. Dermatology. 2020. 236 (1):15-20. [QxMD MEDLINE Link].
Velez A, Alcala J, Fernandez-Roldan JC. Pyoderma gangrenosum associated with acne conglobata. Clin Exp Dermatol. 1995 Nov. 20(6):496-8. [QxMD MEDLINE Link].
Ehrenfeld M, Samra Y, Kaplinsky N. Acne conglobata and arthritis: report of a case and review of the literature. Clin Rheumatol. 1986 Sep. 5(3):407-9. [QxMD MEDLINE Link].
Vasey FB, Fenske NA, Clement GB, Bridgeford PH, Germain BF, Espinoza LR. Immunological studies of the arthritis of acne conglobata and hidradenitis suppurativa. Clin Exp Rheumatol. 1984 Oct-Dec. 2(4):309-11. [QxMD MEDLINE Link].
Ziff M, Maliakkal J. Acne conglobata and arthritis. Ann Intern Med. 1983 Mar. 98(3):417. [QxMD MEDLINE Link].
Roldán JC, Terheyden H, Dunsche A, Kampen WU, Schroeder JO. Acne with chronic recurrent multifocal osteomyelitis involving the mandible as part of the SAPHO syndrome: case report. Br J Oral Maxillofac Surg. 2001 Apr. 39(2):141-4. [QxMD MEDLINE Link].
Birnkrant MJ, Papadopoulos AJ, Schwartz RA, Lambert WC. Pyoderma gangrenosum, acne conglobata, and IgA gammopathy. Int J Dermatol. 2003 Mar. 42(3):213-6. [QxMD MEDLINE Link].
Lim DT, James NM, Hassan S, Khan MA. Spondyloarthritis associated with acne conglobata, hidradenitis suppurativa and dissecting cellulitis of the scalp: a review with illustrative cases. Curr Rheumatol Rep. 2013 Aug. 15(8):346. [QxMD MEDLINE Link].
Guo W, Zhu C, Stevens G, Silverstein D. Analyzing the Efficacy of Isotretinoin in Treating Dissecting Cellulitis: A Literature Review and Meta-Analysis. Drugs R D. 2021 Mar. 21 (1):29-37. [QxMD MEDLINE Link].
Perez-Villa F, Campistol JM, Ferrando J, Botey A. Renal amyloidosis secondary to acne conglobata. Int J Dermatol. 1989 Mar. 28(2):132-3. [QxMD MEDLINE Link].
Freira S, Fonseca H, Ferreira PD, Vasconcelos P, Fonseca JE. SAPHO syndrome in an adolescent: a clinical case with unusual severe systemic impact. J Adolesc Health. 2014 Aug. 55(2):304-6. [QxMD MEDLINE Link].
Leone A, Cassar-Pullicino VN, Casale R, Magarelli N, Semprini A, Colosimo C. The SAPHO syndrome revisited with an emphasis on spinal manifestations. Skeletal Radiol. 2015 Jan. 44(1):9-24. [QxMD MEDLINE Link].
Shimomura Y, Nomoto S, Yamada S, Ito A, Ito K, Ito M. Chronic glomerulonephritis remarkably improved after surgery for acne conglobata of the buttocks. Br J Dermatol. 2001 Aug. 145(2):363-4. [QxMD MEDLINE Link].
Sterling JB, Hanke CW. Dioxin toxicity and chloracne in the Ukraine. J Drugs Dermatol. 2005 Mar-Apr. 4(2):148-50. [QxMD MEDLINE Link].
Ena P, Zanetti S, Sechi LA. Mycobacterium chelonae I infection mimicking acne conglobata in an immunocompetent host. Clin Exp Dermatol. 2004 Jul. 29(4):423-5. [QxMD MEDLINE Link].
Inoue CN, Tanaka Y, Tabata N. Acne conglobata in a long-term survivor with trisomy 13, accompanied by selective IgM deficiency. Am J Med Genet A. 2017 May 7. [QxMD MEDLINE Link].
Tan BB, Lear JT, Smith AG. Acne fulminans and erythema nodosum during isotretinoin therapy responding to dapsone. Clin Exp Dermatol. 1997 Jan. 22(1):26-7. [QxMD MEDLINE Link].
Shirakawa M, Uramoto K, Harada FA. Treatment of acne conglobata with infliximab. J Am Acad Dermatol. 2006 Aug. 55(2):344-6. [QxMD MEDLINE Link].
Bolz S, Jappe U, Hartschuh W. Successful treatment of perifolliculitis capitis abscedens et suffodiens with combined isotretinoin and dapsone. J Dtsch Dermatol Ges. 2008 Jan. 6(1):44-7. [QxMD MEDLINE Link].
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. 2007 Aug. 34(8):583-5. [QxMD MEDLINE Link].
Myers JN, Mason AR, Gillespie LK, Salkey KS. Treatment of acne conglobata with modern external beam radiation. J Am Acad Dermatol. 2009 Aug 6. [QxMD MEDLINE Link].
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. 2011 Jan 25. [QxMD MEDLINE Link].
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. 2012 Feb 1. 13(1):55-9. [QxMD MEDLINE Link].
Leyden JJ, Mills OH, Kligman AM. Cryoprobe treatment of acne conglobata. Br J Dermatol. 1974 Mar. 90(3):335-41. [QxMD MEDLINE Link].
Weinrauch L, Peled I, Hacham-Zadeh S, Wexler MR. Surgical treatment of severe acne conglobata. J Dermatol Surg Oncol. 1981 Jun. 7(6):492-4. [QxMD MEDLINE Link].
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[Guideline] Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May. 74 (5):945-973.e33. [QxMD MEDLINE Link].
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Media Gallery

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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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ryszard Zaba, MD, PhD 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: Sigma Xi, The Scientific Research Honor Society, European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

Acne Conglobata Treatment & Management

Medical Care

Surgical Care

Consultations

References

Tables

Contributor Information and Disclosures

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