What is Acne Conglobata and its Treatment

Acne conglobata is an extremely severe and chronic form of acne vulgaris. In acne conglobata, multiple comedones are surrounded by inflammatory acne nodules. These keep growing bigger until they finally burst and ooze pus. . Keloid-type scars form with crusts over the nodules that become deep ulcers. This deep and irregular scarring develops into deep-seated burrowing abscesses.  Invariably, scars cannot be completely cured although the disease usually dies after the patient turns 30.

Salient characteristics of Acne conglobata are:

  • Deep abscesses
  • Severe scarring
  • Skin getting severely damaged
  • Inflammation
  • Open comedones (blackheads) are widespread and prominent. They occur mainly on the neck, trunk, face, buttocks or upper arms.

Causes of acne conglobata

There is no specific reason why acne conglobata strikes. It can flare-up like a dormant volcano over old acne lesions. Sometimes papules, cysts and pustules that may not heal can rapidly deteriorate and develop into acne conglobata. Males are more likely to develop acne conglobata, than women are. Usually people between the ages of 13 and 18 develop this severe form of acne. 

While there is no specific cause for its onset, changes in reaction to P.acnes bacteria is important. Sometimes, use of anabolic steroids and androgen-producing tumors can cause severe types of acne like acne conglobata to occur. It could affect a person who has stopped testosterone therapy. Acne conglobata can be hereditary and is associated with some types of HLA (human leukocyte) antigens. There is a hereditary link between hidradenitis suppurativa, – an inflammatory disease that is typified by pus-filled abscesses -, aseptic arthritis and pyoderma gangrenosum, which is a genetic condition caused by chromosome 15 defects. 

acne conglobata

Exposure to dioxins or toxic halogen gases and thyroid medication can cause acne conglobata. 

Other causes could be chromosomal defects and renal amyloidosis.

Treatment for acne conglobata

Home remedies or herbal remedies may not be effective against acne conglobata. It must be aggressively treated for it can otherwise leave psychological and physical scars that are disfiguring. Sometimes, if left untreated, acne conglobata can cause aseptic arthritis or become gangrenous. 

The therapy that is believed to be most effective is oral isotretinoin. Sometimes, it is combined with oral prednisolone. Patients often require several years of treatment for acne conglobata to disappear. They will also require period visits to the dermatologist. Since acne conglobata leaves behind deep scars, these will also require treatment. But, it should be taken with caution. Isotretinoin causes serious birth defects in babies. Hence, women of childbearing age must ensure they do not get pregnant during their course of treatment. The usual preventive is to use two types of birth control methods a month before, during and a month after taking isotretinoin. 

Azelaic acid combined with oral antibiotics can also provide relief. Antibiotics usually used are oral erythromycin and oral tetracycline. Oral contraceptives may be effective in women with acne conglobata. Some oral contraceptives can cause ambiguous genitalia in male fetuses. Hence, women must be careful not to get pregnant during this course of medication.

Treatment resistant acne conglobata can be treated with Dapsone. Topical tretinoin combined with carbon dioxide laser therapy has also been effective. Large pus-filled nodules can be aspirated to remove the pus. Other methods used for these severe lesions include cryotherapy or intralesional trimcinolone can be used successfully. Sometimes surgical excision can be adopted if the lesions are interconnected to form large nodules. 

Sometimes systemic steroids will be prescribed. Oral antibiotics must not be used at the same time as isotretinoin for I can increase the risk of contracting pseudotumor cerebri. Modern therapies like external beam radiation have proved effective for severe acne and scars.

Precautions in preventing acne conglobata

Unfortunately, there is no sure preventive measure for acne conglobata. It is important to consult a dermatologist immediately and get aggressive treatment to reduce scarring and psychological impact of this severe form of acne.

Some studies have found that a low glycemic diet can improve acne conglobata. Wash your face and other acne-prone areas regularly with antiseptic gels that could reduce occurrence of P.acnes bacteria. 

Those who have acne conglobata could suffer from stress, anxiety, depression and social embarrassment and may require emotional support.