Acne Conglobata

 

Acne conglobata, a severe form of nodular acne is most common in teenage males but can occur in either sex and into adulthood. Acne conglobata (conglobate means shaped in a rounded mass or ball) is a mixture of comedones, papules, pustules, nodules, abscesses, and scars. It can be on the back, buttocks, chest, and, to a lesser extent, on the abdomen, shoulders, neck, face, upper arms, and thighs . The comedones often have multiple openings. The inflammatory lesions are large, tender, and dusky-colored. The draining lesions discharge a foul-smelling serous, purulent, or mucoid material. Subcutaneous dissection with the formation of multichanneled sinus tracts is common. Healing results in an admixture of depressed and keloidal scars. The management of these patients is very difficult and the effect of treatment is often temporary. Several medications have been used, including intensive high-dose therapy with antibiotics, intralesional glucocorticoids, systemic glucocorticoids, surgical débridement, surgical incision, and surgical excision. The use of isotretinoin has produced dramatic results in some of these patients. In severe cases, dosages as high as 2 mg/kg/day for a 20-week course may be necessary. However, because severe flares may occur when isotretinoin is started, the initial dose should be 0.5 mg/kg/day or less, and systemic glucocorticoids are often required either before initiating isotretinoin therapy or as concomitant therapy.