Acne conglobata L70.1

Most severe, highly inflammatory form of acne with severe seborrhea. Formation of comedones, fistula comedones, numerous inflammatory papules, pustules; highly painful, confluent abscesses and fistula ducts. In some areas, there are also extensive fusions which can undermine a skin area like a foxhole. Healing with extensive, not infrequently also keloid scarring.

Predilection sites of acne vulgaris on the face and trunk. Here with trapezoidal or v-shaped infestation pattern (seborrheic zones).

In addition, areas that are not otherwise affected by vulgar acne such as the neck, capillitium, auricles, extensor side of the upper arms and thighs can be affected. Also buttocks and anogenital area.

Large inflammatory nodes, papules, pustules, painful confluent abscesses. Fluctuating, undermined, deep-lying cavities and fistulas, pronounced scarring tendency. S.a. Acne tetrade, acne triad.

Inflammation parameters moderately or even massively increased.

Antiseptic, cleansing, possibly covering like Acne papulopustulosa and Acne vulgaris. Abscesses are treated with pulling ointment like 50% Ichthyol ointment or Ichtholan special ointment. Fistulas with abscesses or fluctuating abscesses should be incised, followed by an antiseptic dressing with polyvidone-iodine ointments(e.g. Braunovidone-iodine).

Abscessed nodes can be treated with intralesional applications of glucocorticoids.

The first choice is isotretinoin, see also retinoids.

In women, androgenetic contraceptives such as (e.g. Clevia, Esticia, Neo-Eunormin) and antibiotics such as minocycline (e.g. Aknosan, Klinomycin) 2 times/day 50 mg p.o. can be given initially. If this does not produce a satisfactory therapeutic result, isotretinoin (e.g. Aknenormin) should be added.

Note: The teratogenic effect of retinoids must be taken into account in any case, which is why safe contraception must always be guaranteed.

Reminder. During treatment with isotretinoin, no simultaneous administration of tetracyclines, as there is a risk of an increase in intracranial pressure.

Untreated, a chronic course with variable thrust activities over years or decades is possible.

1. Melnik B et al (2007) Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges 5: 110-117
2. Namazi MR et al (2015) Serum levels of hypersensitive C-reactive protein in moderate and severe acne. Indian Dermatol Online J 6: 253-257
3. Yiu ZZ et al (2015) Acne conglobata and adalimumab: use of tumour necrosis factor-α antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol 40: 383-386