[Efficacy of etanercept in the treatment of acne conglobata].

Acne conglobata is a severe form of nodulocystic acne that often represents a therapeutic challenge for dermatologists due to its resistance to the usual therapies. The condition is chronic and disfiguring and has a significant impact on the patient’s quality of life. It presents with numerous comedones, papules, pustules, nodules, and abscesses on the chest, back, face, and neck. Histology usually reveals a perifollicular inflammatory infiltrate, which extends to affect the adjacent dermis. The patient was a 14-year-old adolescent (weight, 60 kg) referred by his primary care physician for management of severe acne that had not responded to topical erythromycin or oral minocycline (100 mg/d for 3 months). Physical examination revealed multiple inflammatory papules, as well as cysts and closed comedones on the face, neck, and upper chest (Figures 1 and 2). The patient had no relevant personal or family history (including laboratory abnormalities such as anemia or hypozincemia or relatives with severe acne or other inflammatory diseases). Blood tests including complete blood count, biochemistry, liver enzymes, and lipid profile were normal, and isotretinoin therapy was therefore started at the doses established for the patient’s weight. After 6 months of treatment, the patient’s condition continued to worsen; consequently, the isotretinoin dose was increased to 60 mg/d. While on this therapy, the patient experienced an outbreak of acne fulminans: the isotretinoin dose was decreased and oral prednisone (30 mg/d) was added. The condition improved partially, and treatment was discontinued. The total cumulative dose of isotretinoin was 10 500 mg. Laboratory