Hafsi Wissem, Arnold David L., Kassardjian Michael
Faculty of Medicine of Tunis, Tunisia
Touro University College of Osteopathic Medicine, CA
Acne conglobata (AC) is a rare but severe form of nodulocystic acne. It usually presents with tender, disfiguring, double or triple interconnecting comedones, cysts, inflammatory nodules, and deep burrowing abscesses on the face, shoulders, back, chest, upper arms, buttocks, and thighs. The comedones often occur in groups of three, and the cysts often contain purulent, foul-smelling material that is discharged on the skin surface. It is a chronic inflammatory disease that inevitably leads to scar formation and disfigurement. Acne conglobata may occur following the sudden worsening of pustular acne, or the disorder may occur gradually following the recrudescence of acne that has been quiet for many years. Acne conglobata is part of the follicular occlusion tetrad, a group of related diseases involving dysfunction of the follicular unit, including dissecting cellulitis, pilonidal disease, and hidradenitis suppurativa (HS). The follicular occlusion tetrad can be exceptionally difficult to treat. Whereas ordinary acne vulgaris can typically be managed with topical agents, AC requires aggressive treatment due to the degree of inflammation and formation of deep nodules and cysts. Acne conglobata may occur in isolation or present with a systemic inflammatory condition, including SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum, acne), PASH syndrome (pyoderma gangrenosum, acne, suppurative hidradenitis), or PAPASH syndrome (pyogenic arthritis, pyoderma gangrenosum, acne, suppurative hidradenitis). The sudden onset of severe acne with oozing and ulcerative lesions in relation to these syndromes or with respect to isotretinoin use is called acne fulminans, an immunologically induced systemic inflammatory response that may have accompanying fevers, malaise, and weight loss. Acne fulminans may arise from pre-existing AC lesions in a patient or may arise entirely de novo after initiation of isotretinoin therapy or concerning anabolic steroid use.
聚合性痤疮（AC）是结节囊肿性痤疮的一种罕见但严重的形式。它通常表现为面部、肩部、背部、胸部、上臂、臀部和大腿上出现疼痛、毁容性的、双连或三联相互连通的粉刺、囊肿、炎性结节和深部潜行性脓肿。粉刺常成三个一组出现，囊肿内通常含有脓性、有臭味的物质，会排出到皮肤表面。这是一种慢性炎症性疾病，不可避免地会导致瘢痕形成和毁容。聚合性痤疮可能在脓疱性痤疮突然加重后出现，或者在多年静止的痤疮复发后逐渐发生。聚合性痤疮是毛囊闭锁三联征的一部分，这是一组涉及毛囊单位功能障碍的相关疾病，包括脓肿性穿掘性头部毛囊周围炎、藏毛窦病和化脓性汗腺炎（HS）。毛囊闭锁三联征可能极难治疗。寻常痤疮通常可用外用药物治疗，而聚合性痤疮由于炎症程度以及深部结节和囊肿的形成，需要积极治疗。聚合性痤疮可能单独出现，或伴有全身性炎症性疾病，包括滑膜炎、痤疮、脓疱病、骨肥厚、骨炎综合征（SAPHO综合征）、化脓性关节炎、坏疽性脓皮病、痤疮综合征（PAPA综合征）、坏疽性脓皮病、痤疮、化脓性汗腺炎综合征（PASH综合征）或化脓性关节炎、坏疽性脓皮病、痤疮、化脓性汗腺炎综合征（PAPASH综合征）。与这些综合征相关或与异维A酸使用有关而突然出现的伴有渗出和溃疡性病变的重度痤疮称为暴发性痤疮，这是一种免疫诱导的全身性炎症反应，可能伴有发热、不适和体重减轻。暴发性痤疮可能源于患者先前存在的聚合性痤疮病变，也可能在开始异维A酸治疗或使用合成代谢类固醇后完全新发。
