Acne Conglobata after Pregnancy

Acne conglobata is an uncommon and severe, inflammatory form of acne vulgaris that is characterized by interconnecting abscesses, draining sinus tracts, and severe disfigurement. We present a case of a 26-year-old female with a past medical history of mild acne that suddenly developed many papules, pustules, and fluctuant nodules on her face and back after pregnancy that was consistent with a diagnosis of acne conglobata. Resolution of the skin lesions was seen after treatment with oral steroids, antibiotics, and retinoids. Maintenance therapy has been with topical retinoids. ABBREVIATIONS AC: Acne Conglobata INTRODUCTION Acne conglobata is a severe, inflammatory form of acne vulgaris. On skin examination, one will characteristically find interconnected abscesses, draining sinus tracts, scarring, and severe disfigurement on the face, chest, arms and back. This condition traditionally affects patients between the ages of 18 to 30. The etiopathogenesis of this condition remains unclear; however, it has a strong positive correlation with high levels of testosterone and is most often seen in males. Treatment typically includes oral isotretinoin and steroids. In the case presentation to follow, we present a case of a 26-year-old female patient who developed acne conglobata after pregnancy. CASE PRESENTATION A 26-year-old female referred to our Acne Clinic by a practical dermatovenereologist because of a severe facial eruption that had developed 6 weeks after giving birth. Her major concerns were her appearance and the painfulness of the lesions. Past medical history was significant for mild acne over the past 10 years along with oral contraception use (ethinylestradiolum + dienogestum) prior to pregnancy. The patient restarted her oral contraception two weeks prior to presenting to our clinic. Review of symptoms was otherwise unremarkable. On physical examination, many papules, pustules and fluctuant nodules were present on her face and back (Figure 1). These findings led to a diagnosis of acne vulgaris and treatment withoral amoxicillin/clavulanate, topical erythromycin and ichtoxyl was initiated. At her follow-up visit, there was no improvement on the aforementioned therapeutic regimen. C-reactive protein (CRP) levels and cultures of the pustules were done. CRP levels were normal and no growth was noted on the cultures. With a lack of therapeutic response and the subsequent findings, a diagnosis of acne conglobata was made. All previous medications were stopped; and to reduce inflammation, the patient was started on a combination of oral doxycycline (200 mg for five days followed by 100 mg for ten days) and prednisone 20 mg orally to reduce inflammation. In addition to systemic therapy, topical therapy consisting of ichtoxyl with salicylic acid 2% was recommended. A rapid therapeutic response was noted within a few days of starting this therapeutic regimen. Thereafter, the steroid dose was reduced by 5mg every week and isotretinoin 0.3 mg/kg/day orally was started on week three of therapy. At baseline, laboratory tests were within normal limits (including CRP), only hypertriglyceridemia was present (3.13 mmol/l). On the face, redness, many papules and some pustules