How is acne conglobata (AC) treated?

Updated: Apr 24, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

The therapy of choice for acne conglobata (AC) includes isotretinoin 0.5-1 mg/kg for 4-6 months.

Simultaneous use of systemic steroids, such as prednisone 1 mg/kg/d for 2-4 weeks, may also prove beneficial, particularly if systemic symptoms are evident.

Alternatives include oral tetracycline, minocycline, or doxycycline. Oral tetracycline antibiotics should not be combined with oral isotretinoin because of an increased risk of pseudotumor cerebri.

For treatment-resistant cases, dapsone 50-150 mg/d is recommended; this treatment should be carefully monitored. [28]

Along with vigorous medical therapy, emotional support is essential.

Treatment of acne conglobata with infliximab has been reported. [29]

Successful treatment of perifolliculitis capitis abscedens et suffodiens, including acne conglobata, has been described with combined isotretinoin and dapsone. [30]

Acne conglobata has been successfully treated by carbon dioxide laser combined with topical tretinoin therapy. [31]

When severe acne conglobata is unresponsive to more accepted options, modern external beam radiation may be an alternative. [32]

The triad of pyoderma gangrenosum, acne, and suppurative hidradenitis, the so-called PASH syndrome, may respond to interleukin 1-beta blockade. [2]

Patients with SAPHO syndrome may benefit from the use of etanercept. [33] or combination treatment with isotretinoin and adalimumab, an antitumor necrosis factor-alpha monoclonal antibody. [34] Another option may be infliximab infusion. [3]

In December 2014, the US Food and Drug Administration (FDA) approved Bellafill, the first dermal filler indicated for acne scarring. Bellafill is a bovine collagen dermal filler.


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