Acne conglobata (AC) occurs when acne cysts and nodules begin to grow together deep below the skin. It’s a form of nodulocystic acne, a rare but serious inflammatory skin condition that primarily forms on your face, back, and chest. Over time, AC causes significant, and sometimes disfiguring, scarring.
Although AC can be severe, medical treatments may help treat the acne while also reducing your risk for scarring. Talk to your dermatologist about all the options available and whether you’re a good fit for some of the more powerful medications.
Nodulocystic acne, such as AC, is characterized by nodules with cyst-like characteristics. Acne nodules develop deep in the pores as a result of clogged bacteria, oil (sebum), and skin cells. The resulting plugs harden and form the nodules.
Eventually, the surrounding area can also become red and swollen. Because of their severity, acne nodules aren’t treatable with over-the-counter remedies.
Nodulocystic bumps aren’t true cysts. Cysts are fluid-filled cavities lined by epithelium tissue. This type of acne doesn’t contain a lining of tissue. And unlike the occasional nodule or cyst, this type of acne involves multiple nodules that connect together.
While nodulocystic acne is rare, the subtype AC is even less common. Not only will you see widespread nodules with AC, but the acne will also build up into large skin-colored comedones. These lumps may also turn into cysts that leak smelly pus when accidentally popped. AC outbreaks are typically worse on your back.
As AC outbreaks build up on your skin, you might develop significant scars. These are classified as thin (atrophic) or thick (hypertrophic).
AC is caused by linking nodules, abscesses, and cysts. It’s difficult to control this type of acne with over-the-counter medication because it spreads deep below your skin through the sinuses.
According to Dermatology and Plastic Surgery, white men are more likely to develop AC. The onset usually occurs during your teens, and symptoms may continue for several years.
In some people, AC is caused by an autoinflammatory disorder. These types of disorders, like autoimmune diseases, are genetic.
If you’re experiencing symptoms of AC or other nodulocystic acne, see your healthcare provider for diagnosis. They’ll look at your lesions and ask you about any known family history of inflammatory skin conditions.
Due to the severity of AC, you’ll likely be referred to a dermatologist. They specialize in diagnosing and treating a variety of skin conditions, including severe acne. Additional tests, such as a biopsy, may be used to rule out other conditions, such as carcinoma.
Given the widespread nature of AC, its treatment is just as complex. Over-the-counter acne treatments don’t work for nodulocystic acne because they only treat the upper layers of skin. AC develops and spreads deep below the skin’s surface, so salicylic acid and other OTC topicals won’t offer any improvements.
Your doctor may recommend a combination of prescription topical and oral medications, as well as scar remedies.
Topical treatments alone won’t work for AC. However, they may be used along with oral medications for better results. The most popular options include prescription formulas of benzoyl peroxide to get rid of sebum and dead skin cells or corticosteroids to reduce inflammation.
The prescription acne medication isotretinoin is the most effective treatment option. It works by stopping excess sebum in the pores. Due to the strength of this medication, you’ll likely only take it on a temporary basis.
Brand names include:
Oral steroids may be used if injectable versions fail to reduce the inflammation surrounding existing nodules.
Women who have AC may benefit from birth control pills or anti-androgen medications. Testosterone is thought to play a role in this type of acne, so certain hormonal drugs could help.
Your doctor may recommend surgery to help treat severe scarring. Your surgeon will use an excision technique to remove scar tissue, and you may be given steroids to help reduce inflammation.
Skin grafting is another technique used for significant scarring. Your surgeon will take tissues from other areas of the body to help fill in the affected area and make it smooth again.
Both surgery and skin grafting can provide relief from discomfort and aesthetic concerns.
Scarring with AC is likely, but early intervention can help reduce future scars. As the condition heals, you may have dark spots. Your dermatologist can help you treat scars with professional dermabrasion or chemical peels.
Skin disfiguration is another possible complication of AC. As with scarring risks, the earlier you treat AC, the less likely you’ll be to develop any deformities. Scars can also become problematic later in life, where tissues break down and cause disfiguration.
Once AC is treated, you might develop secondary comedones later in life. These comedones may be filled with keratin, the main component of outer-skin structure.
Another consideration is the possibility of medication-related side effects. Accutane carries the highest risk. Possible side effects include:
- depression, especially in teens
- pregnancy complications
- sun sensitivity
- sun burns
Due to the inflammatory nature of AC, outbreaks are chronic and ongoing, especially in early adulthood. Teenagers who develop AC may still have this condition well into their 20s and 30s. As you see improvements, you’ll need to stick with your treatment plan to make sure your medications keep working to prevent new nodules from forming.
Your dermatologist will see you at regular intervals to monitor your treatment. It can take months for medications to take full effect, but you should tell your doctor if you’re not seeing any improvements.