Pimples (acne vulgaris, or acne for short) are a common skin condition characterized by chronic or recurrent development of papules, pustules, or nodules on the skin. Pimples are common among adolescents and young adults but can occur at any age.
If your pimple stinks, it may be an uncommon and severe form of nodulocystic acne called acne conglobata, in which large cysts form beneath the skin.
- The nodules usually occur in groups of two or three and connect under the skin.
- The interconnecting abscesses often contain foul-smelling pus and serum.
- Nodules can develop on the chest, the shoulders, the back, the buttocks, the upper arms, the thighs, and the face and they usually cause scarring.
- Acne conglobata affects males more often than females and it usually develops in young adults aged 18 to 30 years, but can occur in infants as well.
What Are Symptoms of Acne Conglobata?
Acne conglobata is more severe than a regular pimple. Symptoms of acne conglobata may include:
- Large, solid, painful lumps under the skin (nodules)
- Painful, pus-filled lumps under the skin (cystic lesions)
- Nodules connect under the skin
- Abscesses under the skin
- Deep inflammation under the skin
- Foul odor from abscesses
Acne conglobata often heals with significant scarring and disfigurement, and patients can have significant emotional effects such as:
- Embarrassment
- Withdrawal
- Self-isolation
- Suicidal ideation
- If you or someone you know are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. Or visit http://www.suicidepreventionlifeline.org.
What Causes Acne Conglobata?
The cause of acne conglobata is unknown. Risk factors that may contribute to the development of acne conglobata include:
- Genetics
- Exposure to halogenated aromatic hydrocarbons (e.g., dioxins)
- Ingestion of halogens (e.g., thyroid medication, hypnotic agents)
- Androgens (e.g., androgen-producing tumors)
- Use of anabolic steroids
- Cessation of testosterone therapy
- Reaction to medications
Acne conglobata may be associated with:
- Hidradenitis suppurativa
- Pyoderma gangrenosum
How Is Acne Conglobata Diagnosed?
Acne conglobata is diagnosed by a dermatologist with a skin examination.
Some other skin conditions may look like acne conglobata, but are not, and require different treatment. This is why it is important to get a diagnosis from a dermatologist to rule out conditions that resemble acne conglobata, such as:
- Acne and suppurative hidradenitis (PASH) syndrome
- Acne fulminans
- Acne vulgaris
- Acneiform papulonodules
- Bromoderma
- Iododerma
- Rosacea fulminans
What Is the Treatment for Acne Conglobata?
The main treatment for acne conglobata is isotretinoin for four to six months.
Systemic steroids, such as prednisone, used for two to four weeks along with isotretinoin, may benefit some patients.
Alternative medications include:
For treatment-resistant cases, dapsone is recommended.
Emotional support is also recommended due to the psychological effects of this disfiguring form of acne.
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https://www.ncbi.nlm.nih.gov/books/NBK459219/
https://emedicine.medscape.com/article/1072716-overview