Acne conglobate is a rare yet severe form of acne that typically presents with deep burrowing abscesses. The disease, which is mostly observed in young adults, is associated with scar formation and disfigurement. Acne conglobate is often found on the chest, buttocks, face, shoulder, upper arms, and thigh. A review of the disorder, and its management, was provided by researchers in a book published by StatPearl Publishing.
Acne conglobate comedones occur in groups of 3, and cysts feature purulent and offensive-smelling material that discharge onto the surface of the skin. Clinicians, particularly primary care providers and nurse practitioners, are urged to understand the differences between acne conglobate and acne fulminans, as these 2 diseases both share the presence of inflammatory nodules on the trunk. Generally, acne conglobate can be differentiated from acne fulminans in that the disease causes polyporous comedones and noninflammatory cysts, features of which are not common in the latter disease.
The bacterium involved in acne vulgaris – Propionibacterium acnes – may also play a role in acne conglobate by changing the bacteria’s reactivity as an antigen. Hypersensitivity to P. acnes antigens results in an immunological response that leads to a chronic inflammatory state. In addition, androgens and anabolic steroids as well as exposure to thyroid medications and halogenated aromatic hydrocarbons may result in the formation of acne conglobate. Hiding the disease with clothing can sometimes lead to excessive warmth and humidity in the area of the acne, and these conditions can worsen the disease.
Retinoids, including isotretinoin, are the preferred treatment of choice for acne conglobate. Oral retinoids are sometimes prescribed for 20 to 28 weeks, depending on the patient. In contrast, topical retinoids do not appear to be as effective as their oral counterparts. Oral prednisone of 1 mg/kg/day for 14 to 28 days is also recommended by some dermatology experts. Steroids may be effective if a patient has systemic constitutional symptoms, including fever, general malaise, loss of appetite, and weight loss. Treatment with dermal fillers can also be used to improve the appearance of scars.
Clinicians are advised to recommend psychological counseling to patients with acne conglobate if the disease has affected their mental health. In addition, these patients may wish to consider starting antidepressants or anti-anxiety medications although receiving care for their skin condition from a dermatologist.
Hafsi W, Badri T. Acne conglobata. [Updated 2020 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459219/.