Acne conglobata and acne fulminans

Acne conglobata describes a situation where there is severe nodular acne causing deep abscesses, sinuses in the skin and skin breakdown leading to ulceration. There are also usually large numbers of blackheads affecting the face, neck, upper arms and trunk.

Acne fulminans is a severe form of acne conglobata where the patient becomes systemically unwell. Patients will present with nodular cystic acne plus a number of other symptoms including malaise, fever, joint pain and/or swelling. It nearly always affects males and is characterised by an abrupt onset along with the above symptoms and a raised white blood cell count. It may be precipitated by the illegal use of testosterone to boost muscle growth; however, it can just occur spontaneously (New Zealand Dermatological Society Incorporated, 2009). It is considered a dermatological emergency and a patient presenting with acne fulminans must be referred urgently to see a dermatologist (National Institute for Clinical Excellence, 2001).

Acne conglobata and fulminans can present as part of a syndrome known as SAPHO. This syndrome must include any combination of the following:

Synovitis (inflamed joints)
Acne (conglobata or fulminans)
Pustulosis (thick blister containing yellow pus)
Hyperostosis (increase in bone substance)
Osteitis (inflammation of the bones)

Treatment will be multifactorial involving care from dermatologists and rheumatologists in order to treat all of the symptoms.