Acne conglobata L70.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

acne conglobata

Definition
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Most severe highly inflammatory form of acne with severe seborrhea; with formation of comedones, fistula comedones, numerous inflammatory papules, pustules, highly painful, confluent abscesses and fistula ducts. In some places there is also extensive melting which can undermine an area of skin like a foxhole. Healing with extensive, often keloid scarring.

Localization
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Predilection sites of acne vulgaris on the face and trunk. Here with trapezoidal or v-shaped infestation pattern (seborrheic zones).

In addition, areas that are not otherwise affected by vulgar acne such as the neck, capillitium, auricles, extensor side of the upper arms and thighs can be affected. Also buttocks and anogenital area.

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Clinical features
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Large inflammatory nodes, papules, pustules, painful confluent abscesses. Fluctuating, undermined, deep-lying cavities and fistulas, pronounced scarring tendency. S.a. Acne tetrade, acne triad.

Laboratory
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Inflammation parameters moderately or even massively increased.

Differential diagnosis
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External therapy
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Antiseptic, cleansing, possibly covering like Acne papulopustulosa and Acne vulgaris. Abscesses are treated with pulling ointment like 50% Ichthyol ointment or Ichtholan special ointment. Fistulas with abscesses or fluctuating abscesses should be incised, followed by an antiseptic dressing with polyvidone-iodine ointments(e.g. Braunovidone-iodine).

Abscessed nodes can be treated with intralesional applications of glucocorticoids.

Internal therapy
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First choice isotretinoin, s.a. Retinoids.

In women, androgenetically effective contraceptives, such as (e.g. Clevia, Esticia, Neo-Eunormin) and antibiotics such as Minocycline (e.g. Aknosan, Klinomycin) can be given 2 times/day 50 mg p.o. initially. If this does not lead to a satisfactory result, treatment with isotretinoin (e.g. acnenormin) should be used.

Note: The teratogenic effect of retinoids must be taken into account in any case, which is why safe contraception must always be ensured.

Notice! When treating with isotretinoin, do not administer tetracyclines at the same time, as there is a risk of cerebral pressure increase.

Operative therapie
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Progression/forecast
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Untreated, a chronic course with variable thrust activities over years or decades is possible.

Literature
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  1. Melnik B et al (2007) Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges 5: 110-117
  2. Namazi MR et al (2015) Serum levels of hypersensitive C-reactive protein in moderate and severe acne. Indian Dermatol Online J 6: 253-257
  3. Yiu ZZ et al (2015) Acne conglobata and adalimumab: use of tumour necrosis factor-α antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol 40: 383-386

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020