From the Guidelines
The recommended treatment for acne conglobata is oral isotretinoin at doses of 0.5-1 mg/kg/day for 15-20 weeks, as it has been shown to significantly reduce the size and secretion of sebaceous glands, decrease surface and ductal level of sebum-dependent C. acnes, and possess anti-inflammatory properties 1. This approach is supported by a RCT of 33 patients with treatment-resistant cystic and conglobate acne, where the mean number of cystic lesions decreased by 17% and 33% at 1 and 2 months of isotretinoin treatment 1. Some key points to consider when treating acne conglobata with isotretinoin include:
- Baseline blood tests, including lipid profiles and liver function tests, are necessary before starting treatment, with regular monitoring throughout 1
- Women must use effective contraception due to isotretinoin's teratogenic effects 1
- Alternative regimens, such as oral antibiotics combined with topical retinoids, may be considered for patients who cannot tolerate isotretinoin 1
- Intralesional corticosteroid injections and surgical intervention, including incision and drainage, may be necessary for particularly painful nodules or large abscesses 1
- Treatment is typically long-term, as acne conglobata is chronic and recalcitrant, with the goal of preventing permanent scarring and psychological distress 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Acne Conglobata
The recommended treatment for acne conglobata includes:
- Oral isotretinoin, which is considered the treatment of choice for severe papulopustular and nodulocystic/conglobate acne 2, 3
- Combined systemic therapies of high-dose antibiotics, systemic corticosteroids, and sulfones, which take precedence over topical preparations in conglobate acne and acne fulminans 3
- A combination of topical 20% azelaic acid cream and oral minocycline, which is an effective treatment in severe forms of acne and is better tolerated and associated with fewer risks than oral isotretinoin 4
Comparison of Treatment Options
Studies have compared the efficacy and safety of different treatment options for acne conglobata, including:
- A comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin, which found that the combined treatment was effective in nodular forms of acne, but not quite as effective as treatment with oral isotretinoin 4
- A review of 25 cases of acne fulminans, which found that the preferred treatment is oral prednisolone and oral isotretinoin, with the oral steroid being used sooner rather than later 5
General Treatment Guidelines for Acne
General treatment guidelines for acne vulgaris include: