By Gary M. White, MD
Chronic inflammatory lesions leed to pitted scars.
Acne conglobata (AC) is an uncommon variant of acne that typically affects the cheeks, trunk and buttocks. In contrast to typical acne, AC usually persists well into the adult years.
Numerous comedones, papules, pustules, nodules, abscesses, and draining sinus tracts involving the cheeks, chest, back and buttocks are typical. The lesion characteristic of AC is the larger comedone with multiple openings (agminated comedone). The patient tends to develop much scarring over time. Although there is overlap with hidradenitis superativa (HS), HS tends to involve the body folds (e.g., occluded areas of the breasts, axilla, and groin).
Oral antibiotics such as tetracycline 500 mg, doxycycline 100 mg, or minocycline 100 mg all BID may be tried. A course of isotretinoin may help, but is not as effective as in acne vulgaris. Adalimumab has been very effective in a small number of case reports [JAMA Derm 2013:149;1306]. Incision and drainage of acutely inflamed or fluctuant areas may be necessary. Chronically draining sinus tracts may need to be externalized.
Inflammatory lesions in a typical location.
Severe, pitting scarring develops over time.
Illustration of the bridge and the result of deroofing the lesion.
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