Causes and risk factors
It affects individuals between 18 and 30 years of age. It is common in men. It usually persists for a very long time until the patient is around 40 years old. It usually occurs where there is already an underlying acne problem. The exact cause of this type of acne is unknown. It is associated with the condition called ‘hidradenitis suppurativa.’ It is associated with testosterone and thus appears mainly in men. It can be caused by anabolic steroid abuse and sometimes appears in men on stopping testosterone therapy. It can also cause in people who have a tumour that is releasing large amounts of androgens. If a person is predisposed to it, the condition can be triggered by exposure to aromatic hydrocarbons or ingestion of halogens. Genetic changes have also been stated to cause acne conglobata. Chromosomal defects in XXY karyotype has been responsible for severe form of acne conglobata.
Clinical presentation
Lesions of acne conglobata usually occur on the face, neck, trunk, and upper extremities. It is seen in areas that contain sweat glands, e.g., armpits, groin, buttocks, scalp, and under the breast. It can present as cluster of 2 or 3 blackheads that communicate under the skin. Severe form may present as extensive deep inflammation which leads to painful abscesses. These heal incompletely and cause cord-like scars on the skin. The infection can progress under the skin connecting the abscesses. These boils can be very painful and restrict movement of the affected area.
Investigation
Medical history by the patient and Clinical examination by the dermatologist helps in diagnosis. Skin biopsy may be recommended.
Treatment
Antibiotics help in treating acne conglobata. Medicated local applications may be prescribed, but are less effective. Steroids may be required in some cases. Retinoids are commonly prescribed by dermatologist. Aggressive laser therapies contribute further to the treatment.
Other Modes of treatment
The other modes of treatment can also be effective in treating acne conglobata. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the Ayurvedic system of medicine, which uses herbal medicines and synthetic derivates, is also found to be effective in treating acne conglobata.
