An Overview of Acne Conglobata

Acne conglobata is a very severe, but fairly rare, form of inflammatory acne. Acne conglobata causes large inflammatory pimples, papules, and deep nodules. Nodules grow very large and are often dome-shaped. Breakouts often drain bad-smelling pus.

What separates acne conglobata from the more common nodulocystic acne is that acne conglobata causes large draining abscesses and sinus tracts. Now, these sinus tracts don't have anything to do with the sinuses of your respiratory tract. Sinus tracts are long, tunneling wounds under the surface of the skin.

In acne conglobata, deep breakouts grow and spread beneath the skin's surface. The breakouts join up with each other, causing these deep wounds.

Causes

Just like with most cases of acne, there's no definitive answer as to why acne conglobata suddenly develops. Acne conglobata often starts as typical acne vulgaris that slowly gets worse. Sometimes it appears quite suddenly, long after a previous case of acne has been cleared up.

Speculation is that the body suddenly becomes hypersensitive to Propionibacteria acnes, the bacteria that's a key contributor to acne development, and overreacts, causing severe inflammation and breakout development.

Acne conglobata is far and away more common in men, especially during early adulthood (20s and 30s). It is very uncommon in women and is extremely rare in children or older people.

What we do know is certain things tend to act as triggers. Because acne conglobata is more often seen in men, testosterone is likely a contributing factor to its development.

Anabolic steroid use is a big trigger. This type of acne is seen at a higher rate in bodybuilders than in the general population. If you develop severe acne and use (or have used) steroids for bodybuilding, let your healthcare provider know. That key piece of information can help your dermatologist treat your acne effectively.

Other triggers are androgen-producing tumors and thyroid medications. For women, polycystic ovary syndrome (PCOS) may be an underlying trigger. It's also seen more often in men who have taken testosterone treatments and can appear after treatment is stopped.

Acne conglobata runs in families, so it may have a genetic component. Common acne itself seems to run in families, especially severe forms of acne. Acne conglobata is linked to hidradenitis suppurativa and pyoderma gangrenosum and is seen more often in people with these conditions.

Symptoms

Acne conglobata typically occurs on the back and chest, shoulders, thighs, and buttocks, as well as the face. You'll get lines of breakouts, rather than single blemishes, as they grow and interconnect beneath the skin. There are a few key distinctions that can help differentiate acne conglobata from severe cases of the more common nodulocystic acne (often called cystic acne).

One is the way that blackheads develop. Blackheads, obviously, are incredibly common and nearly everyone gets them, even people without acne. Whereas, typically, blackheads appear singularly, in acne conglobata blackheads nearly always appear in groups of two or three. These become inflamed and grow to large, painful nodules.

Blackheads and other non-inflamed comedones (aka pore blockages) can grow really large as well, up to 3 centimeters across. These large pore blockages are called "macrocomedones."

As the skin tries to heal, a scab forms in the middle of the blemish. Acne conglobata nodules are notoriously slow healers and continue to spread outward even as the scab develops in the middle of the breakout.

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Acne Conglobata vs. Acne Fulminans

Acne conglobata looks very much like another rare type of acne called "acne fulminans." The biggest difference between these two types of acne is that people with acne conglobata also have non-inflamed breakouts, like those blackheads we talked about earlier. Non-inflamed breakouts aren't apparent in those with acne fulminans.

Also, with acne fulminans, the breakouts tend to stay open and may weep, rather than scab over. Acne fulminans tends to develop much more rapidly than acne conglobata and also can appear with fever and pain in the bones and joints.

Treatment

Acne conglobata is challenging to treat. This type of acne absolutely must be treated by a dermatologist. Isotretinoin is by far the most common treatment and is generally the first treatment prescribed.

Oral antibiotics are another common treatment choice. They may be used after the course of isotretinoin has stopped, or in place of isotretinoin if that medication can't be used.

Tetracycline, minocycline, and doxycycline are generally prescribed. Sometimes oral dapsone is used if you aren't garnering results with the aforementioned antibiotics.

Oral steroids like prednisone may also be prescribed to help reduce inflammation. There are some reports of improvement with the immunosupressive medication infliximab.

Some practitioners have had good results with CO2 laser plus topical tretinoin, especially in cases where oral medications aren't helping.

If acne conglobata is not getting any better no matter what treatment is used, the next step is to try to physically remove the infected nodules. Nodules may be suctioned out from the skin, or surgically removed. Cryotherapy can be used to freeze lesions. Your dermatologist may also inject triamcinolone into nodules to help shrink them and facilitate healing.

The key is to get treatment early; acne conglobata can spread quickly. Since acne conglobata does extreme damage to the skin's structure, it almost always leaves scarring, unfortunately. Getting the nodules under control is the pressing goal. Once acne is reasonably controlled, you and your dermatologist can start talking about scar treatment options.

Know that treatment takes several months to really start working. During this time you'll be monitored closely by your dermatologist to ensure everything is going as planned, and he or she may make tweaks to your treatment plan as needed. It's incredibly important that you meet with your dermatologist regularly and stay super consistent with your treatment plan.

A Word From Verywell

Just because your acne is severe, it doesn't automatically mean you have acne conglobata. Acne conglobata is rare, so odds are what you really have is nodulocystic acne vulgaris.

All severe forms of acne must be treated by a dermatologist anyway, so if you have severe acne, make an appointment ASAP. Your dermatologist will accurately diagnose your skin problem and, most importantly, come up with a treatment plan to help improve your skin.

Severe acne can be debilitating, both physically and emotionally. Keep your healthcare provider, your family, and close friends keyed in to how you're doing. If you're feeling overwhelmed or depressed, or you're showing any signs of depression, let your healthcare provider know. Lean on your loved ones for support. Dealing with acne conglobata is challenging, but you can get through it.