User:Sk2457/Acne conglobata

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Acne conglobata [AC] is a severe type of nodulocystic acne presenting with comedones, nodules, abscesses, and draining sinus tracts. It is a chronic condition that can lead to permanent scarring without aggressive treatment. As a part of the follicular occlusion tetrad, the disease is associated with other systemic inflammatory conditions caused by malfunction of the follicular unit.

This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. A variety of factors contribute to the development of AC. The pathogen Cutibacterium acnes causes an inflammatory response in the follicle, and the accumulation of keratinocytes and sebum forms a nodule or cyst. It is associated with testosterone and appears mainly in males and athletes. It can be caused by anabolic steroid abuse and sometimes appears in males after stopping testosterone therapy. It can also happen to someone who has a tumor that is releasing large amounts of androgens, or to people in remission from diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens

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Presentation Acne conglobata is a severe, inflammatory variant of acne. Unlike other acne related conditions, AC can cause disfiguring and odorous abscesses. Inflammatory papules, papulonodules, nodules and pustules often interconnect in groups of three, leading to larger and more painful lesions. Bleeding or draining of acneiform plaques may be present. The systemic findings seen in acne fulminans are not present. A component of the follicular occlusion tetrad, acne conglobata may be seen with hidradenitis suppurativa, pilonidal disease and dissecting cellulitis of the scalp. The face, chest, back and buttocks may be involved.

Diagnosis

A formal diagnosis for AC is necessary to determine the most appropriate course of treatment. Pus formation and odorous discharge indicate the need for antibiotics, and fluids must be cultured to find an effective long term solution. More severe symptoms such as nausea, fever, or weight loss may indicate the presence of other related inflammatory skin conditions such as SAPHO syndrome, PAPA syndrome, PASH syndrome, PAPASH syndrome, or acne fulminant.

Treatment

The most common treatment is some form of retinoids such as the acne medication isotretinoin. However, in some cases it can worsen symptoms leading to acne fulminant. In this case, corticosteroids like prednisone are prescribed for 2-4 weeks before isotretinoin can be used again. Antimicrobials or hormone therapy may also be used for long term treatment. Corticosteroids like prednisone have been shown to be effective. Antibiotics such as dapsone, tetracycline or erythromycin may also be prescribed. An option to treat with carbon dioxide laser therapy, followed by topical tretinoin therapy has been described.

Surgery may be necessary to remove large nodules. Alternatively, nodules can be injected with corticosteroids such as triamcinolone.