TibotSkin ProblemAcne & RosaceaAcne Conglobata

Acne Conglobata

Acne conglobata is a highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts. This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. Although the cause of this type of acne is unknown, it is associated with testosterone and thus appears mainly in men. It can be caused by anabolic steroid abuse and sometimes appears in men after stopping testosterone therapy. It can also happen to someone who has a tumor that is releasing large amounts of androgens, or to people in remission from diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens.

This severe and painful disease occurs most frequently in young men about 16 years old, it may extend and persist into adulthood and even into the fifth decade of life, especially over the posterior neck and back. Women are less frequently affected. Athletes and bodybuilders should be questioned about the use of antibiotic, steroids, which may induce such aggressive acne. 

Acne conglobata is caused by linking nodules, abscesses, and cysts. It’s difficult to control this type of acne with over-the-counter medication because it spreads deep below your skin through the sinuses.  

Given the widespread nature of Acne conglobata, its treatment is just as complex. Over-the-counter acne treatments don’t work for nodulocystic acne because they only treat the upper layers of skin. Acne conglobata develops and spreads deep below the skin’s surface, so salicylic acid and other OTC topicals won’t offer any improvements. 

Doctor may recommend a combination of prescription topical and oral medications, as well as scar remedies. 

Topical treatments 

Topical treatments alone won’t work for Acne conglobata. However, they may be used along with oral medications for better results. The most popular options include prescription formulas of benzoyl peroxide to get rid of sebum and dead skin cells or corticosteroids to reduce inflammation. 

Oral medications 

The prescription acne medication isotretinoin is the most effective treatment option. It works by stopping excess sebum in the pores. Due to the strength of this medication, it will only take it on a temporary basis.  

Oral steroids may be used if injectable versions fail to reduce the inflammation surrounding existing nodules.  

Women who have Acne conglobata may benefit from birth control pills or anti-androgen medications. Testosterone is thought to play a role in this type of acne, so certain hormonal drugs could help. 

Oral medications 

The prescription acne medication isotretinoin is the most effective treatment option. It works by stopping excess sebum in the pores. Due to the strength of this medication, it will only take it on a temporary basis.  

Oral steroids may be used if injectable versions fail to reduce the inflammation surrounding existing nodules.  

Women who have Acne conglobata may benefit from birth control pills or anti-androgen medications. Testosterone is thought to play a role in this type of acne, so certain hormonal drugs could help. 

Scar remedies 

Doctor will recommend surgery to treat severe scarring. Surgeon will use an excision technique to remove scar tissue, and also given steroids to help reduce inflammation. Skin grafting is used for significant scarring. Surgeon will take tissues from other areas of the body to help fill in the affected area and make it smooth again.  

Both surgery and skin grafting can provide relief from discomfort and aesthetic concerns. 

 

Medical Care 

The therapy of choice in all but the earliest lesions is isotretinoin, 0.5-1 mg/kg/day to a total dose of 150 mg/kg, with a second course if resolution does not occur after a rest period of 2 months. Pretreatment with prednisone1 mg/kg/d for 2-4 weeks, and low initial doses of isotretinoin, are recommended to avoid flaring of disease. 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. Carbon dioxide (CO2) fractional laser abrasion of cysts, external beam radiation, and infliximab are other reported therapies. Infliximab cleared a patient in whom pyoderma gangrenosum, acne conglobata, suppurative hidradentis (PASH) alone or with coexisting axial spondyloarthritis (PASS syndrome). 

Along with vigorous medical therapy, emotional support is essential. 

 

Surgical Care 

Large hemorrhagic nodules may be aspirated. 

Intralesional triamcinolone or cryotherapy may also be valuable.  

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

 

Talk to your dermatologist about all the options available and whether you’re a good fit for some of the more powerful medications. It may be wise to order routine screening for psychological disturbance in adolescents with acne conglobata.

  • Andrew’s Diseases of the skin
  • ABC Of Dermatology
TibotSkin ProblemAcne & RosaceaAcne Conglobata

Acne Conglobata

TUI - Tibot Urgency Index

Acne conglobata is a highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts. This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. Although the cause of this type of acne is unknown, it is associated with testosterone and thus appears mainly in men. It can be caused by anabolic steroid abuse and sometimes appears in men after stopping testosterone therapy. It can also happen to someone who has a tumor that is releasing large amounts of androgens, or to people in remission from diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens.

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Dr. Lora Smith

MBBS (Dhaka), DGO (DU) Ex SR. Gynaecologist & Obstetrician

09 606 111 222

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