Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 8/15/2021
Acne is never welcome, and whether you have mild acne like blackheads and whiteheads or more moderate displays such as papules or pustules — seeing your skin erupt into inflamed pimples can be disconcerting.
There are some forms of acne that are particularly severe, however, and which can cause both physical and emotional pain.
Acne conglobata is a type of severe acne that can greatly impact your quality of life.
The good news is that acne conglobata is relatively rare, and while it’s a severe form of acne — there are ways to heal it.
Read on to learn what causes acne conglobata, symptoms that distinguish it from other types of acne, and the most potent ways to treat it — to avoid severe scarring, and improve your skin.
Acne conglobata is a form of nodulocystic acne characterized by inflamed, painful nodules (acne blemishes) that penetrate deep into the skin.
These lesions can unfortunately lead to irregular scars when they heal.
Acne conglobata comedones (acne bumps) usually appear in groups of three and form cysts that often contain unpleasant smelling pus.
Nodules and cysts can grow together to produce this condition.
An inflammatory disorder, acne conglobata can be found on the shoulders, upper arms, chest, back, buttocks, thighs, face and in very rare cases — the scalp.
This condition may be the result of acne that has worsened over time or it may simply recur on its own — even after a number of years.
If you know your acne, this condition might seem awfully similar to acne fulminans, a condition distinguished by painful, pustular acne lesions, usually with open sores.
Acne fulminans usually presents with a systemic disease such as a fever or arthritis, which helps set it apart from acne conglobata.
These non-inflammatory cysts are called polyporus comedones.
Another distinguishing feature that helps acne conglobata stand out is that it’s made up of deep abscesses (pockets of pus), which work together to form a network of connected sores.
The question is, how?
Acne conglobata is believed to be caused by Propionibacterium acnes or P.acnes, the same type of bacteria to blame for regular acne vulgaris.
However, to produce this skin condition, this organism causes the body to have a hypersensitive reaction — leading to a chronic inflammatory state.
P.acnes also causes the body to develop pus, as well as sinus tracts which allow liquid to escape.
One thing to note is that this pus usually (and unfortunately) stinks, and should be left alone so as not to cause further infection and inflammation.
Other potential acne conglobata causes include thyroid medication and exposure to halogenated aromatic hydrocarbons which are commonly used in pesticides and solvents.
Acne conglobata may also present in patients with hidradenitis suppurativa, a chronic skin condition that causes lumps in areas such as the groin.
Androgen hormones as well as synthetic or anabolic steroids can also be risk factors for acne conglobata, which may explain why it’s common to see bodybuilders with this type of acne.
Acne conglobata can also occur in people who stop taking synthetic hormones, or it may be a reaction to other hormonal substances.
This nodular form of acne is more commonly observed in men than in women, yet usually presents with similar indicators including:
Tender, swollen nodules
Red, inflamed areas surrounding the nodules
Atrophic scars resembling sunken areas on the skin
Hypertrophic scars which are usually thick and raised on the skin
While this form of acne may appear to be big and scary, the good news is that it is fixable and can be managed with the right acne treatment plan.
It’s possible to use one or multiple methods to tackle the condition, including:
Antibiotics for acne are popularly employed to help manage different types of acne.
Minocycline, tetracycline or doxycycline are typically recommended for inflammatory acne like acne conglobata.
Oral antibiotics help manage acne production that may be causing follicular obstruction within the skin.
They also have anti-inflammatory effects that can help with managing acne breakouts on the skin.
This is an oral prescription medication belonging to the retinoid family. Thanks to its ability to influence the sebaceous glands that produce oil in the body, isotretinoin is often recommended for managing severe acne.
In fact, it can be ideal for treatment-resistant acne conglobata when other measures such as antibiotics haven’t helped.
Isotretinoin is believed to not only reduce the size of sebaceous glands, but may also help reduce sebum production.
To manage acne, topical retinoids such as tretinoin, adapalene and tazarotene are usually popular choices.
Retinoids can help prevent the formation of comedones and perform anti-inflammatory functions in the skin.
However, in severe cases, these topical treatments may not be as effective as their oral counterparts.
(For mild to moderate forms of acne however, over-the-counter treatments containing retinoids may be helpful.
This prescription Acne Cream with Tretinoin may help improve your pimples, and it can be customized specifically for your skin.)
Dark spots and acne scarring resulting from acne conglobata may sometimes require surgical treatments such as carbon dioxide laser resurfacing.
This can help stimulate collagen production where scarring is present.
Dermal fillers can also be helpful in healing scars caused by acne conglobata. These fillers can also stimulate collagen production, which further helps improve your skin’s appearance.
Acne conglobata is probably one of the last skin conditions you’d want to deal with.
This form of acne involves big, painful lesions and can leave some unsightly scarring in its wake.
As mentioned above, acne conglobata is manageable — thanks to retinoids, antibiotics and cosmetic procedures to bring it under control.
For best results and to see if you in fact have acne conglobata, it’s wise to consult with a healthcare professional.