Acne Conglobata: What to Know About This Inflammatory Skin Condition

Medically Reviewed By Joan Paul, MD, MPH, DTMH
Was this helpful?
2

Acne conglobata is a severe form of acne that results in nodules and cysts on the skin. Scarring is common, and, in some cases, disfigurement can occur. This inflammatory skin condition typically starts in teens and can affect many body areas. This article explains acne conglobata and how it is diagnosed and treated.

What is acne conglobata?

Person with acne taking a selfie
Olga Sibirskaya/Stocksy United

Acne conglobata is a rare but severe acne characterized by scar formation and disfigurement. The areas most commonly affected include:

  • chest
  • face
  • shoulders
  • upper arms
  • buttocks
  • thighs

This type of acne is mainly found in people assigned male at birth and usually starts in the teen years. Acne conglobata is a variant of nodulocystic acne, which presents as nodules and cysts that lead to scarring.

Acne conglobata is not very common and is rarely seen in children or older people. It becomes increasingly active in people in their teens and 20s.

Several reports over the past few decades note that this type of acne has become increasingly present in athletes who use anabolic steroids.

What are the symptoms of acne conglobata?

Some common symptoms of acne conglobata include:

  • clusters of blackheads on the trunk, neck, upper arms, and buttocks
  • nodular lesions that are tender and dome-shaped
  • skin hyperpigmentation
  • scarring
  • purulent, foul-smelling discharge from the nodules
  • facial disfigurement

What does acne conglobata look like?

An image depicting acne conglobata
Acne conglobata is a rare inflammatory acne condition in which acne cysts grow together, forming large abscesses below the skin. Photography by DermNet New Zealand

Acne conglobata consists of nodules and cysts on the face and body, often red in appearance. The area around the acne may look inflamed, and blackheads are usually present in clusters.

The nodules and cysts are usually firm and tender. In people of color, hyperpigmentation and keloid scarring are common.

What causes acne conglobata?

Experts believe that Propionibacterium acnes, the same organism involved in acne vulgaris, may play a role in acne conglobata. This is because hypersensitivity to this organism induces an immunological reaction that causes a chronic inflammatory state.

Thyroid medications, androgens, and anabolic steroids also trigger acne conglobata. This type of acne has also been linked to HLA phenotypes and people with the XYY karyotype.

What are the risk factors for acne conglobata?

Risks factors for acne conglobata include:

  • being assigned male at birth
  • being in your teen years or 20s
  • taking certain medications, such as anabolic steroids and thyroid medications
  • having another follicular occlusion condition (diseases where keratin blocks hair follicles, causing them to rupture), such as hidradenitis suppurativa

Acne conglobata is also related to other types of skin conditions, including:

  • acne and suppurative hidradenitis
  • acne fulminans
  • acne vulgaris
  • rosacea fulminans

How do you prevent acne conglobata?

Acne conglobata is challenging to prevent because it is an inflammatory condition caused by an immune system response.

Taking good care of your skin and practicing good hygiene can help keep your skin healthy and less prone to developing acne.

Self-care tips include:

  • use skin products specifically for people with sensitive skin
  • avoid harsh soaps and skin care products
  • drink plenty of water
  • eat a healthy diet
  • avoid processed foods and excess sugar

How do doctors diagnose acne conglobata?

Acne conglobata is typically diagnosed by a dermatologist. Your doctor will examine your skin and look at the presentation of clinical symptoms.

If there is discharge from the nodules, your doctor will likely take a sample and send it to be cultured to identify if bacteria are present. This will help the doctor determine the best course of treatment.

How do you treat acne conglobata?

The treatment for acne conglobata is oral retinoids, such as isotretinoin, for at least 5 months. Topical retinoids may be used, but they are not as effective as the oral form. Oral retinoids are not given during pregnancy.

Other treatment options include:

  • antibiotics, such as minocycline, tetracycline, or doxycycline, to treat bacterial infections
  • systematic corticosteroids to reduce inflammation
  • external beam radiation, in severe cases that do not respond to retinoids or antibiotics
  • aspirating very large painful nodules to drain them
  • intralesional steroid injections into very large nodules or cysts
  • surgery to remove very large nodules
  • dermal fillers can help with the appearance of scars once lesions have healed
  • Adalimumab, a biologic medication used to treat other inflammatory conditions, may be used off-label for severe cases

How does acne conglobata affect quality of life?

Acne conglobata can affect a person’s self-esteem and self-confidence, especially if it appears on the face.

People with severe acne may not want to go out in public or socialize because the acne is very noticeable. This can cause isolation and loneliness.

People with acne conglobata can experience anxiety and depression related to the condition. It can help to seek the help of a qualified therapist who can work with you to develop ways of coping with severe acne.

With proper treatment, severe acne can heal. Many new treatments can reduce the appearance of acne scars.

What are the potential complications of acne conglobata?

If acne conglobata isn’t treated properly, abscesses can form on the skin, leading to more severe scarring and inflammation. Surgery may be necessary if an abscess forms or if nodules are very large.

Suicidal ideations are common in people with acne conglobata because of the embarrassment associated with disfigurement. A person may become withdrawn and isolated. Mental health counseling is very important in this population.

Frequently asked questions

Here are some frequently asked questions people have about acne conglobata.

Does acne conglobata go away on its own?

Acne conglobata typically requires treatment and will not go away on its own. Oral retinoids are the best treatment for this type of acne. In some cases, doctors prescribe antibiotics. It’s important not to try to hide the acne with garments, as this can lead to excess warmth and humidity, which worsens the condition.

Is acne conglobata cystic acne?

Acne conglobata is a form of nodulocystic acne characterized by large nodules and cysts on the skin. It is an inflammatory skin condition that is rare but severe.

Summary

Acne conglobata is a severe form of acne. It often presents as large nodules and cysts on the face, trunk, or buttocks. Immune system response is thought to play a role in causing an inflammatory state. A dermatologist can help diagnose and treat acne conglobata. The best form of treatment is oral retinoids and antibiotics as needed.

People with acne conglobata may become isolated if they avoid socializing due to the disfigurement caused by the condition. Mental health counseling can help people dealing with the psychological effects of this condition.

Was this helpful?
2
Medical Reviewer: Joan Paul, MD, MPH, DTMH
Last Review Date: 2023 Jan 9
View All Acne Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Acne: Acne conglobata. (2021). https://www.pcds.org.uk/clinical-guidance/acne-conglobata
  2. Hafsi, W., et al. (2021). Acne conglobata. https://www.ncbi.nlm.nih.gov/books/NBK459219/
  3. Nodulocystic acne. (2021). https://dermnetnz.org/topics/nodulocystic-acne
  4. Xu, Shuangyan, et al. (2021). The analysis of acne increasing suicide risk. https://journals.lww.com/md-journal/Fulltext/2021/06180/The_analysis_of_acne_increasing_suicide_risk.3#