WHAT IS ACNE CONGLOBATA?Acne conglobata is a severe form of acne that develops not only pimples but also large bumps, pus-filled cavities (cysts), and scarring. It's a variant of regular acne, but much more severe. Individual pimples and cavities can merge into large patches. It's most common on the back, shoulders, chest, and face. It's also called acne conglobata et cystica (with cysts).
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acne conglobata |
WHO GETS ACNE CONGLOBATA?Like regular acne, acne conglobata develops from puberty onward. It can also begin in young adulthood. It can persist for a long time, up to the ages of 35-40. It's more common in men than women, but women can also have it. It's related to testosterone levels in the blood.HOW DOES ACNE CONGLOBATA OCCUR?Acne conglobata develops during puberty under the influence of hormones such as testosterone. These hormones stimulate hair follicles and sebaceous glands, resulting in hair growth and increased sebum production. Blocked hair follicles and overgrowth of skin bacteria cause pimples, which in acne conglobata develop into deep inflammations (boils, abscesses), which can also develop into closed-off cavities (medically known as cysts) filled with pus or sebum. Scarring develops around the inflammation, which can cause bulging bumps. It is unknown why some people develop this severe form of acne. Sometimes it runs in families. Smoking may also play a role. Acne conglobata can also be caused by medications that disrupt hormonal balance, such as corticosteroids and the anabolic steroids sometimes used by bodybuilders, and by exposure to chlorine compounds such as pesticides.WHAT DOES ACNE CONGLOBATA LOOK LIKE?Acne conglobata occurs primarily on the back, shoulders, chest, and face. Just like with regular acne, pustules and whiteheads and blackheads are present. The pustules are often larger and more severe than with regular acne and develop into subcutaneous inflammation (abscesses). Cavities (cysts) develop that are closed off and filled with pus or sebum. These often gradually enlarge. Smaller areas can merge into larger areas. Connections (called tunnels or fistulas) can develop between the various areas. Scarring forms around the inflammation. Sometimes, an acne conglobata patient suddenly develops so much inflammation around the acne areas that general symptoms such as fever, general malaise, joint pain, and even blood poisoning develop. This acute condition is also called acne fumninans.HOW IS THE DIAGNOSIS MADE?The diagnosis is based on the clinical picture and its appearance. No further testing is necessary. In cases of acne fulminans with fever, blood tests are sometimes performed to determine the severity of the inflammation.HOW IS ACNE CONGLOBATA TREATED?Once it's clear that acne conglobata is involved, strong medications such as isotretinoin, antibiotics, and sometimes even prednisone are often prescribed temporarily. This is necessary to prevent severe scarring.
Isotretinoin:
Isotretinoin is a vitamin A-derived medication used for severe acne. It's a powerful agent, but it also has side effects. Isotretinoin affects the structure of the skin and the stratum corneum, thinning these layers. This reduces the risk of clogged pores. Furthermore, isotretinoin reduces sebum production and inhibits inflammation. It also inhibits the growth of acne bacteria. The drug is teratogenic, meaning it causes serious abnormalities in the unborn child. Women taking this drug must absolutely not become pregnant. It also causes dry skin, lips, and eyes. Isotretinoin is usually prescribed for a longer period, often longer than six months.
Antibiotics:
If isotretinoin causes too many side effects or cannot be prescribed for other reasons, antibiotics are used. These are specific antibiotics with anti-inflammatory side effects that can be prescribed for long periods. Examples of these antibiotics include doxycycline, minocycline, erythromycin, clarithromycin, azithromycin, and clindamycin. They are often combined with topical products that dissolve the stratum corneum, such as benzoyl peroxide gel, Acid-A-Vit (vitamin A acid cream), or Differin (adapalene) gel.
Dapsone:
Dapsone is also an antibiotic with anti-inflammatory side effects. It is sometimes used for acne conglobata, but not as a first-line treatment due to its side effects (including anemia).
Prednisone:
For severe inflammation (acne fulminans), prednisone is sometimes prescribed in combination with antibiotics, either for a short period or in a low dose.
TNF-alpha inhibitors
TNF-alpha inhibitors such as infliximab and adalimumab are biologics, expensive medications administered by injection or intravenous drip. They are registered for the acne variant acne ectopica (also called hidradenitis suppurativa). They have also been tried for acne conglobata and acne fulminans. They inhibit inflammation, but their use is not without risk because the immune system is suppressed, and they are not reimbursed because they are not registered for acne conglobata.
Laser therapy
The scars caused by acne conglobata can potentially be treated with fractionated CO2 laser therapy.
Topical corticosteroids
Topical corticosteroids, in the form of a cream or a liquid (Kenacort A10) injected into the abscesses, can reduce inflammation.
Surgery for residual
scars Scars, abscess cavities, and cysts that are very thick and persistent can be surgically removed.
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WHAT CAN YOU STILL DO YOURSELF?Don't squeeze the pimples; this usually has a counterproductive effect.
Isotretinoin treatment makes the skin very dry. Use a moisturizer, a lip balm, and be careful with contact lenses. Read the instructions carefully.
Don't use a tanning bed; it's not effective against acne conglobata. |
