Acne is a common concern for many, but when it transforms into the severe form known as acne conglobata, it can become an even more challenging hurdle to contend with. 

But with professional help and the right treatment and lifestyle changes, you can combat acne conglobata and get on the path to clear skin. Here, our licensed dermatology professionals will unpack acne conglobata’s symptoms, causes, and treatment options.

What is acne conglobata? Understanding your symptoms

Acne conglobata is a severe, rare type of acne. This chronic inflammatory condition is often characterized by painful and disfiguring features, including double or triple-interconnected comedones (whiteheads or blackheads), cysts, inflammatory nodules, and deeply burrowed abscesses.¹

This condition predominantly appears in high sebum production areas such as the face, shoulders, back, chest, upper arms, buttocks, and thighs. A unique characteristic of acne conglobata is that the comedones frequently appear in clusters of three. Cysts associated with this condition also often contain foul-smelling material, which may discharge onto the skin's surface.²

Without proper treatment, acne conglobata can lead to scar formation. For this reason, early identification and appropriate management are necessary to minimize the damage and heal properly.

What causes acne conglobata? 

While the exact cause of acne conglobata is unknown, it is understood to be an inflammatory response, with potential genetic contributors.

Inflammatory response

Acne conglobata emerges due to a complex interplay of factors associated with inflammation. For instance, individuals who develop this condition likely experience significant dysbiosis, which refers to a substantial imbalance or disruption in the natural composition of your skin microorganisms. This imbalance provokes an exaggerated inflammatory reaction to acne-causing bacteria, beyond that typically seen in acne-prone skin.³

The onset of acne conglobata can be sudden, often following a rapid worsening of pustular acne, or it may develop gradually over time. In some cases, it can manifest after the re-emergence of acne that has remained dormant for many years.⁴

Environmental and lifestyle factors may also contribute to the development of this condition. Exposure to certain industrial chemicals like halogenated aromatic hydrocarbons and the use of certain substances, such as anabolic steroids, have been associated with the onset of acne conglobata.⁵

The role of genes in acne conglobata 

Research has linked acne vulgaris, another common form of acne, to genetic components, suggesting that a predisposition to some forms of acne may be inherited.⁶ From this, we can speculate that if you have a family history of acne, especially severe forms like acne conglobata, you may have a higher risk of developing it yourself. However, it’s important to note that no direct genetic cause has been pinpointed for acne conglobata through research. 

Treatment options 

Dealing with acne conglobata is a journey that you shouldn’t face alone. Seeking professional medical advice is essential to ensure you receive the most appropriate and effective treatment. Your healthcare provider can present a range of treatment options tailored to your specific needs. These can range from oral retinoids which can help reduce inflammation and clear clogged pores, to antibiotics that target acne-causing bacteria. Topical retinoids are also an option for some people. 

In some instances, advanced therapeutic methods like laser therapy can be employed to target and reduce severe acne, and surgical intervention may be considered to manage complex cases.⁷

Remember, every journey begins with a single step, and reaching out for professional help is the first step towards clearer, healthier skin.

Oral and topical retinoids 

Embarking on the path to clear skin from acne conglobata involves a comprehensive treatment strategy, often including a potent oral retinoid know as isotretinoin. This medication, usually administered for a duration of 20-28 weeks or longer, is known for its efficacy in controlling severe acne by reducing inflammation and managing overactive oil glands.

However, flare-ups can occur, especially during the early stages of isotretinoin treatment. Should this happen, your healthcare provider may introduce oral prednisone into your regimen. Steroids, like prednisone, are known for their strong anti-inflammatory properties can be effective in managing such flare-ups.⁸ Topical retinoids are also often use along with isotretinoin to help reduce acne and inflammation. 

Antibiotics 

In the battle against acne conglobata, antibiotics like minocycline or doxycycline can serve as powerful allies. Generally administered at a dosage of 100 mg twice daily, these tetracycline-class antibiotics work diligently to curb the acne-causing bacteria on your skin, reducing inflammation and preventing new breakouts. However, an essential part of effective treatment is understanding potential interactions between medications—these antibiotics should not be used in conjunction with oral isotretinoin. This combination carries a risk of inducing pseudotumor cerebri, a condition that mimics the symptoms of a brain tumor.⁹

Your healthcare provider will be mindful of this potential interaction, and will guide your treatment plan accordingly to ensure your journey to clear skin is both safe and effective.

Laser therapy 

There are several types of laser therapies that have shown promise in treating acne conglobata, as documented in case reports. These include fractional and ablative carbon dioxide lasers, Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) lasers, and vascular lasers.¹⁰

While laser therapy can be effective in some cases, a healthcare professional can provide guidance based on your specific skin condition and needs.

Surgical intervention 

Surgical interventions such as aspiration, cryotherapy, and surgical excision may be required to alleviate your symptoms and enhance the appearance of your skin. These procedures often work in conjunction with pharmacological therapies to provide a comprehensive treatment strategy.¹¹

After the active acne lesions have healed, the focus often shifts to improving the appearance of scars left behind. One commonly effective approach is the use of dermal fillers, which have been approved by the FDA for the treatment of acne scarring. These fillers work by plumping up the skin beneath your scar, helping to smooth the skin's surface and reduce the visibility of scars. It's important to note that patients should be tested for allergies before receiving fillers, particularly those derived from animal sources such as bovine or rooster comb, to prevent potential allergic reactions.¹²

The role of a dermatology provider in treating acne conglobata 

Navigating the challenging terrain of acne conglobata necessitates expertise, and that's precisely where a dermatology provider comes in. Due to the severe nature of this condition and the potential for lasting scarring and disfigurement, self-treatment is not recommended.

Acne conglobata is more than just a skin condition; it's a complex disorder that requires a multi-faceted approach to treatment. Dermatologists are skilled in assessing your individual case, determining the best course of action, and monitoring progress throughout treatment. They can prescribe a suitable combination of oral and topical medications, and guide you through more advanced treatment options like laser therapy or surgical interventions if necessary.

Take care of your skin with Curology 

If you're dealing with the challenges of acne conglobata, or any form of acne for that matter, it's important to find a personalized skincare regimen that works for you. Though we don’t treat acne congolobata specifically, our Custom FormulaRx may help you improve your skin health and clear your general acne. 

Formulated by dermatology experts, our Custom FormulaRx targets your unique skin issues, including acne, with a blend of prescription-grade ingredients. It's custom-tailored to your skin and your skin alone.

Complement your customized treatment with a specially designed acne cleanser and acne body wash as well. These products are formulated to keep your skin clean, reduce excess oil, and fight acne-causing bacteria. Regular use of these products can help clear up acne and prevent future breakouts, supporting your journey to healthier skin.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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Don't let acne control your life. Take the first step towards clear skin today by signing up for a 30-day trial.* 

Remember, the journey to clear skin starts with a single step!

P.S. We did the homework so you don’t have to:

1. Hafsi, W., et al. Acne Conglobata. StatPearls. (2023, January 13).

2. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

3. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

4. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

5. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

6. Heng, A.H.S., et al. Gene variants associated with acne vulgaris presentation and severity: a systematic review and meta-analysis. BMC Med Genomics. (2021, April 13).

7. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

8. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

9. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

10. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

11. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

12. U.S. Food & Drug Administration. Dermal Fillers (Soft Tissue Fillers). (2021, October 8).

13. Hafsi, W., et al. Acne Conglobata. StatPearls. Ibid.

14. Zito, P.M. and Badri, T. Acne Fulminans. StatPearls. (2023, March 7).

Meredith Hartle is a board-certified Family Medicine physician at Curology. She earned her medical degree at Kirksville College of Osteopathic Medicine in Kirksville, MO.

*Cancel anytime. Subject to consultation. Results may vary.

Written by

Curology Team

Medically reviewed by

Meredith Hartle, DO