Acne conglobata
Encyclopedia
Acne conglobata is a highly inflammatory disease presenting with comedones, nodules
, abscess
es, 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 tumour that is releasing large amounts of androgens, or to people in remission from autoimmune diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens.
s appearing around the face, neck, chest, upper arms and buttocks in groups of two or three. The pimples form around the blackheads. They are large and engorged with fluid, and may be sensitive to touch. They remain for a while and continue to grow and fill with pus
until they finally rupture. After the lesion has drained, it fills up again. After they rupture, several nodules can fuse together to form larger shapes. The lesions remain for a long time. They form a scab in the centre but they continue to spread outwards. When the lesions do eventually heal, they leave scars that can be the usual type of acne scar (atrophic) or can be the raised bump normally left behind by a burn or a cut (keloidal).
. It may be combined with prednisone
. Dapsone, which is normally used to treat leprosy, is a riskier medication but is sometimes prescribed in cases where the normal therapy is ineffectual. Antibiotics such as tetracycline or erythromycin
may also be prescribed. An alternative option is to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy.
Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with triamcinolone
.
Nodule (medicine)
For use of the term nodule in dermatology, see Nodule In medicine, a nodule refers to a relatively hard, roughly spherical abnormal structure....
, abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
es, 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
Acne
Acne is a general term used for acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:*Acne aestivalis*Acne conglobata*Acne cosmetica*Acne fulminans*Acne keloidalis nuchae*Acne mechanica...
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
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
and thus appears mainly in men. It can be caused by anabolic steroid
Anabolic steroid
Anabolic steroids, technically known as anabolic-androgen steroids or colloquially simply as "steroids", are drugs that mimic the effects of testosterone and dihydrotestosterone in the body. They increase protein synthesis within cells, which results in the buildup of cellular tissue ,...
abuse and sometimes appears in men after stopping testosterone therapy. It can also happen to someone who has a tumour that is releasing large amounts of androgens, or to people in remission from autoimmune diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens.
Appearance
This condition presents with blackheadBlackhead
A blackhead is a yellow or blackish bump or plug on the skin. A blackhead is a type of acne vulgaris. Contrary to the common belief that it is caused by poor hygiene, blackheads are caused by excess oils that have accumulated in the sebaceous gland's duct...
s appearing around the face, neck, chest, upper arms and buttocks in groups of two or three. The pimples form around the blackheads. They are large and engorged with fluid, and may be sensitive to touch. They remain for a while and continue to grow and fill with pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...
until they finally rupture. After the lesion has drained, it fills up again. After they rupture, several nodules can fuse together to form larger shapes. The lesions remain for a long time. They form a scab in the centre but they continue to spread outwards. When the lesions do eventually heal, they leave scars that can be the usual type of acne scar (atrophic) or can be the raised bump normally left behind by a burn or a cut (keloidal).
Treatment
The most common treatment is the acne medication isotretinoinIsotretinoin
Isotretinoin, INN, is a medication used mostly for cystic acne. It was first developed for brain, pancreatic and other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. Its effects are systemic and nonselective...
. It may be combined with prednisone
Prednisone
Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug. It is used to treat certain inflammatory diseases and some types of cancer, but has significant adverse effects...
. Dapsone, which is normally used to treat leprosy, is a riskier medication but is sometimes prescribed in cases where the normal therapy is ineffectual. Antibiotics such as tetracycline or erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
may also be prescribed. An alternative option is to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy.
Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with triamcinolone
Triamcinolone
Triamcinolone is a long-acting synthetic corticosteroid given orally, by injection, inhalation, or as a topical ointment or cream....
.