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Acne conglobata - Skin in Adult
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Acne conglobata - Skin in Adult

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Contributors: Amy Fox MD, David Dasher MD, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Acne conglobata is a disease that falls along the continuum of acne and tends to present as a painful, disfiguring, recalcitrant collection of interconnecting cysts, nodules, sinuses, and abscesses on the face, neck, chest, back, and shoulders. Whereas ordinary comedonal or inflammatory acne can frequently be controlled with topical agents, this disease often requires more aggressive treatment because of the intense degree of inflammation as well as the formation of deep nodules and cysts.

Acne conglobata can be seen as part of the follicular occlusion tetrad which includes dissecting cellulitis, pilonidal cysts, and hidradenitis suppurativa. The follicular occlusion tetrad is difficult to treat, as there are few effective treatment modalities available.

Pathogenesis is thought to be primary occlusion of the pilosebaceous unit followed by rupture with subsequent profound inflammatory response and frequent secondary infections. Lesions heal with scarring. Acne conglobata can run within families, and it typically affects young men around age 16. Women are affected less frequently.

Codes

ICD10CM:
L70.1 – Acne conglobata

SNOMEDCT:
42228007 – Acne conglobata

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acne vulgaris – A milder form encompassing either comedonal or inflammatory lesions. Deep cyst or abscess formation is unusual.
  • Medication-induced disease – A few cases of acne conglobata following lithium use have been reported. This should resolve after discontinuation of medication. A careful drug history is important to ensure the patient is not taking androgenic steroids that could also cause a similar picture.
  • Pseudofolliculitis barbae – Lesions are restricted to the beard region in men. It is typically less severe in presentation, but it can have similar inflammatory nodules.
  • Acne fulminans – Severe inflammatory acne with conglobate lesions and extensive involvement (often on the chest, back, and arms) in association with pain, tenderness, fever, malaise, and occasionally joint symptoms.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 08/12/2013
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Acne conglobata - Skin in Adult
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Acne conglobata : Cyst, Primarily truncal, Pustule
Clinical image of Acne conglobata
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