Deroofing combined with photodynamic therapy and secukinumab: An effective therapy for acne conglobates with underlying follicular occlusion spectrum diseases.

Severe acne conglobate (AC) with concurrent follicular occlusion diseases strongly resists standard therapies. Therefore, we evaluated a novel combined treatment for these complex cases. This retrospective study included eight male patients with refractory syndromic AC. First, patients underwent localized surgical deroofing to remove deep-seated lesions. Immediately afterward, we applied 20% ALA-PDT once weekly for three consecutive weeks. Concurrently, all patients received systemic secukinumab as maintenance therapy. Clinical and patient-reported outcomes were assessed at 64 weeks. The combined therapy yielded significant clinical improvements. Mean lesion counts dropped dramatically from 19.9 to 3.1 (P = 0.012). By week 64, five patients (62.5%) achieved a "clear" or "almost clear" status. Furthermore, this approach greatly relieved the patients' psychosocial burden. Mean DLQI scores fell from 18.1 to 5.9 (P = 0.012), and most patients (87.5%) reported maximum satisfaction. The treatment was well-tolerated, with no severe adverse events or excessive scarring observed. Combining surgical deroofing and ALA-PDT with secukinumab is highly effective. This combined strategy provides a potentially safe and durable solution for severe syndromic AC. The combination should be further explored in a larger patient population.