How to Identify and Treat Acne Conglobata

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Acne conglobata is a rare but severe form of inflammatory acne that causes pockets of pus under the skin that interconnect into tunneling wounds. This can lead to severe, permanent scarring. The face, shoulders, back, chest, buttocks, and thighs are most commonly affected.

Acne conglobata can be challenging to treat and may require a drug called Accutane (isotretinoin) or a course of oral antibiotics. Although the exact cause is unknown, genetics and hormonal imbalances are thought to play a role. Males are affected more than females.

This article looks at the symptoms and causes of acne conglobata. It also explains how the condition is diagnosed and treated, including the best ways to heal acne scars.

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Acne conglobata
Acne conglobata. Dr. Milton Reisch / Getty Images

Symptoms of Acne Conglobata

Acne conglobata is a rare type of nodulocystic acne. Nodulocystic acne is so-named because it causes the formation of pustular (pus-filled) nodules or cysts under the skin. (Nodules are deeper and firmer than cysts).

Nodulocystis acne typically causes isolated nodules. With acne conglobata, multiple nodules develop the eventually interconnect into pus-filled tunnels.

The nodules often start as comedones (also known as whiteheads and blackheads). These non-inflammatory bumps can sometimes become infected, causing pus to accumulate and penetrate deeper layers of the skin.

Acne conglobata occurs because comedones develop in clusters. In other instances, acne conglobata can develop on skin that is heavily populated with oil-producing sebaceous glands.

Acne conglobata is characterized by the following signs and symptoms:

  • Tight clusters of acne nodules that are red, swollen, and firm to the touch, mainly on the face, shoulders, back, chest, upper arms, buttocks, and thighs
  • Acne nodules that form in a line or "chain"
  • Acne nodules surrounded by blackheads or whiteheads
  • Pain and tenderness when touching the lumps
  • Foul-smelling pus
  • Scabbing of inflamed or broken tissues

Because of the tunneling beneath the skin, acne conglobata can lead to severe scarring. In chronic (persistent) cases, the scarring can be disfiguring.

Acne nodules are notoriously slow to heal and can continue to spread outward even as the scabs form on damaged skin.

Acne Conglobata Causes

As with other cases of acne, there is no definitive answer as to why acne conglobata occurs.

With that said, acne conglobata is thought to be strongly influenced by the hormone testosterone. This is the sex hormone that triggers secondary male characteristics (like facial hair and body size) and also stimulates the production of skin oils from the sebaceous glands.

An imbalance in testosterone is strongly linked to acne conglobata. This is evidenced by risk factors associated with the condition.

This includes:

  • Being male: Acne conglobata is far more common in males, especially those in their 20s and 30s when testosterone levels are at their highest. It is uncommon in women and extremely rare in children and older people.
  • Anabolic steroid use: Man-made anabolic steroids help build muscles by acting like testosterone. Bodybuilders who "juice" are at especially high risk of acne conglobata.
  • Polycystic ovary syndrome (PCOS): Acne conglobata is common among females with PCOS. This hormonal disorder is characterized by high testosterone levels which can lead to the onset of acne, facial hair, and male pattern hair loss.
  • Hidradenitis suppurativa: This is an inflammatory skin condition that affects females more than males. In females, testosterone levels are characteristically increased. Acne conglobata is a frequent feature of hidradenitis suppurativa.

Acne conglobata also occurs in families, suggesting a genetic link. Other types of acne also run in families, especially severe inflammatory forms.

Diagnosing Acne Conglobata

Acne conglobata is typically diagnosed with a physical exam and a review of your medical history (including family history and medications you take). Most cases can be diagnosed based on the symptoms alone.

Even so, your healthcare provider may take a sample of pus to determine which type of bacteria is involved. This can help them select the most effective antibiotic drug.

The healthcare provider may also order tests if they suspect you have an underlying condition like PCOS or hidradenitis suppurativa.

When to See a Healthcare Provider

According to the American Academy of Dermatology Association, you should see a dermatologist if you have any form of severe acne.

Indications include:

  • Chronic or recurrent acne outbreaks
  • Acne that fails to respond to over-the-counter medications
  • Acne that cleared with prescription drugs but then reappeared after six months
  • Pimples in unusual places, such as the armpit, groin, thigh, or back of the upper arm
  • Deep, painful acne cysts or nodules
  • Severe acne scarring
  • Feeling depressed, anxious, or reluctant to socialize because of your acne

Treating Acne Conglobata

Acne conglobata is challenging to treat and needs to be seen by a dermatologist who may prescribe specific medications or therapies.

Among the prescription drug options:

  • Accutane (isotretinoin), an oral drug, is generally the first treatment prescribed.
  • Oral antibiotics like tetracycline, minocycline, or doxycycline may be used after isotretinoin is used or in place of isotretinoin if the drug can't be taken.
  • Oral steroids like prednisone may help reduce acne inflammation.
  • Remicade (infliximab), an oral immunosuppressant, has also shown promise in the treatment of acne conglobata.
  • Topical tretinoin combined with laser therapy may offer good results when oral medications aren't helping.
  • Injected triamcinolone, a type of steroid, can help shrink the nodules if other options fail.

The treatment of acne conglobata can take several months to start working, but with persistence, positive results can be achieved.

If acne conglobata is still not getting any better, the next step may be to remove the infected nodules. This can be done with suctioning, surgery, or cryotherapy (cold therapy).

Scar Treatment

The scarring caused by acne conglobata can sometimes be disfiguring since deep tissues are involved. This can lead to pockmarks or areas of shiny, lighter-colored skin called keloid scars.

Because of the potentially disfiguring effects, the treatment needs to be more aggressive. Among the options:

  • Surgical excision may be used to cut away scar tissues and suture together the cut ends. A plastic surgeon may be needed if facial scars are involved. Steroids may be prescribed to reduce inflammation.
  • Skin grafting may be needed if scarring is extensive and deep. This involves the removal of a skin sample from another part of your body to fill in the affected area. Dermal fillers, delivered by injection, can fill in smaller pockmarks.

Outlook for Acne Conglobata

Acne conglobata is a long-lasting condition, but with the appropriate treatment, it can be effectively managed over the long term.

No form of acne, including acne conglobata, can be "cured." However, if the acne is caused by anabolic steroids or a hormonal imbalance, it may clear once the condition is resolved.

Studies suggest that acne conglobata can be an ongoing concern for as long as three decades. After that, it often spontaneously clears on its own.

Summary

Acne conglobata is a severe form of acne in which deep pockets of pus, called pustular nodules, merge and interconnect beneath the skin. This can cause hardened, painful lumps and disfiguring scars. The cause of acne conglobata is unknown but testosterone and genetics are thought to play a part. Accutane (isotretinoin) and oral antibiotics are commonly prescribed.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Angela Palmer
Angela Palmer is a licensed esthetician specializing in acne treatment.