Acne Conglobata: Understanding This Rare Form of Acne and Management Strategies.

Acne conglobata is a severe, often eruptive, form of acne included in the follicular occlusion tetrad along with hidradenitis suppurativa, pilonidal cysts, and dissecting cellulitis of the scalp. The pathogenesis is complex and likely multifactorial with contribution from both extrinsic and intrinsic factors. Studies have shown a slight male predominance. Acne conglobata is clinically characterized by large, purulent nodules and abscesses, coalescing into large masses or plaques. It is often recalcitrant to common acne therapies, making management difficult for clinicians. Isotretinoin is considered the first-line therapy but must be started at a conservative dosage as it can paradoxically worsen flares. Biologic agents, such as tumor necrosis factor (TNF) and interleukin (IL)-17 inhibitors, along with photodynamic therapy (PDT) and carbon dioxide (CO2) laser therapy have been reported as effective. Large prospective studies focusing on the management of acne conglobata are lacking. Acne conglobata often causes severe scarring, creating a large psychosocial burden for the patient and negatively impacting quality of life.