Int J Womens Dermatol 2017 Sep 13;3(3):145-150. Epub 2017 Jul 13.

Department of Dermatology, University of Connecticut Health Center, Farmington, CT.

The treatment of acne during pregnancy is often limited by the potential toxicities that are posed to the fetus by the most common and effective acne therapies. As with all dermatoses during pregnancy, the treatment of acne vulgaris in this population requires a thorough understanding of the risks and benefits that are inherent to each treatment. We report on a case of a 30-year-old pregnant patient with severe acne conglobata who showed significant improvement with a combination treatment of topical modalities, oral metronidazole, and low dose prednisone during pregnancy. Read More

Eur J Dermatol 2017 Jun;27(3):320-321

Department of Dermatology, Allergology, Universitiy Hospital of Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.

Am J Med Genet A 2017 May 7. Epub 2017 May 7.

Department of Dermatology, Red Cross Sendai Hospital, Sendai, Japan.

Trisomy 13 (T13) is a congenital chromosomal disorder that is usually fatal within 2 years of birth, and only a few patients have been reported to reach adolescence. Here, we report a male long-term survivor of T13, currently 15 years of age, with a several-year history of extensive acne conglobata (AC) with abscesses on the face and neck. Methicillin-resistant Staphylococcus aureus was consistently isolated from the pustular lesions. Read More

Acta Derm Venereol 2017 Aug;97(8):969-970

Dermatology Clinic, University of Catania, AOU Policlinico-Vittorio Emanuele, Via Santa Sofia, 78, IT-95123, Catania, Italy. *E-mail:

Clin Dermatol 2017 Mar - Apr;35(2):138-146. Epub 2016 Oct 27.

Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, Dragoumi str, 16121, Athens, Greece.

Acne is the most common of skin diseases, being characterized as a chronic inflammatory disease of the pilosebaceous unit. Although acne is usually straightforward to diagnose and treat, some patients have difficult or rare forms of acne. What seems to be "nonresponding acne" in a patient may be caused by another acneiform disease that clinically mimics acne, thus misleading the clinician, if not ruled out, with scrutiny. Read More

Int J Dermatol 2017 Jun 14;56(6):660-663. Epub 2017 Feb 14.

Department of Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany.

Background: Hidradenitis suppurativa (HS) has recently been described as a component of two autoinflammatory syndromes: PASH (pyoderma gangrenosum, acne, and HS) and PAPASH (pyoderma gangrenosum, acne, pyogenic arthritis, and HS). These associations together with others such as inflammatory bowel diseases suggest that defects in autoinflammatory pathways may play a role in the pathogenesis of HS.

Objectives: To describe clinical and genetic characteristics of two unrelated patients with HS and familial Mediterranean fever (FMF). Read More

Reumatol Clin 2016 Dec 16. Epub 2016 Dec 16.

Unidad de Gestión Clínica de Pediatría, Hospital Universitario San Cecilio, Granada, España.

The acronym of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) combines a cluster of cutaneous and musculoskeletal manifestations, such as hyperostosis of bones of the anterior chest wall associated with acne fulminans and hidradenitis suppurativa. There are no validated diagnostic criteria in children. Nonsteroidal anti-inflammatory drugs are not always sufficient, and the use of corticosteroids, disease-modifying agents, tumor necrosis factor-α inhibitors or bisphosphonates may be necessary. Read More

G Ital Dermatol Venereol 2016 Oct;151(5):553-7

Section of Dermatology, Department of Medical Sciences, S. Anna Hospital, Ferrara University Hospitals, Ferrara, Italy -

Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Read More

Neth J Med 2016 Jul;74(6):272

Department of Internal Medicine, Division of Tropical Diseases, Academic Medical Centre, Amsterdam, the Netherlands.

Dermatol Ther 2016 Nov 18;29(6):455-458. Epub 2016 Jul 18.

Department of Dermatology, Brigham and Women's Hospital.

Hidradenitis suppurativa is a member of the follicular occlusion tetrad, along with acne conglobata, dissecting cellulitis of the scalp and pilodinal sinus. These conditions share common pathophysiologic features, including follicle occlusion, bacterial overgrowth, severe suppurative inflammation, scarring, and sinus tract formation. Treatment of severe cases is challenging, and a novel treatment modality would be of significant value. Read More

Dent Update 2016 Jan-Feb;43(1):93-4

Australas J Dermatol 2017 May 2;58(2):e54-e59. Epub 2016 Feb 2.

Clinic of Dermatovenereology, Clinical Centre of Serbia, Belgrade, Serbia.

The clinical triad of pyoderma gangrenosum, acne conglobata and hidradenitis suppurativa has been named PASH syndrome. Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and inflammation. Hidradenitis suppurativa, like acne vulgaris, may be a feature of hyperandrogenism. Read More

Exp Dermatol 2016 Apr 11;25(4):314-6. Epub 2016 Feb 11.

Green Cross Voluntary Blood Bank, Ahmedabad, India.

Indian Dermatol Online J 2015 Jul-Aug;6(4):253-7

Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. Read More

Dermatol Ther 2015 May-Jun;28(3):158-65. Epub 2015 Mar 3.

Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

Tumor necrosis factor-alpha (TNF)-alpha inhibitors are licensed for patients with severe refractory psoriasis and psoriatic arthritis. However, TNF-alpha inhibitors have also been used off-label for various recalcitrant mucocutaneous diseases. This study aimed to evaluate the efficacy and safety of TNF-alpha inhibitors used for off-label dermatological indications. Read More

Clin Exp Dermatol 2015 Jun 26;40(4):383-6. Epub 2014 Dec 26.

Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.

Acne conglobata (AC) is a chronic, severe, inflammatory variant of acne characterized by development of cystic nodules, abscesses and sinus tracts. AC may prove resistant to conventional acne therapy. The off-label use of adalimumab for the treatment of AC has been reported recently. Read More

Indian Dermatol Online J 2014 Oct;5(4):491-3

Department of Dermatology, Cutis Academy of Cutaneous Sciences, Bangalore, Karnataka, India.

Follicular occlusion tetrad is a symptom complex consisting of four conditions having a similar pathophysiology. It includes Hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus. The exact pathogenesis of this group of disease is unknown but evidence suggests that they share the same pathological process initiated by follicular occlusion in apocrine gland bearing areas. Read More

Skeletal Radiol 2015 Jan 21;44(1):9-24. Epub 2014 Oct 21.

Department of Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168, Rome, Italy,

The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome includes a group of chronic, relapsing, inflammatory musculoskeletal disorders with similar manifestations, in particular synovitis, hyperostosis, and osteitis, which may or may not be associated with neutrophilic skin eruptions such as palmoplantar pustulosis and acne conglobata. The syndrome occurs at any age, can involve any skeletal site, and its imaging appearances are variable, depending on the stage/age of the lesion and imaging method. The diagnosis is difficult if there is no skin disease. Read More

J Am Acad Dermatol 2015 Mar 12;72(3):550-3. Epub 2014 Aug 12.

Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Electronic address:

Key teaching points • Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is characterized by distinctive osteoarticular manifestations and a spectrum of neutrophilic dermatoses. • The most common dermatologic manifestations include palmoplantar pustulosis, acne conglobata, and acne fulminans. • SAPHO syndrome should be considered in patients presenting osteoarticular pain, particularly involving the anterior chest wall and/or spine, and neutrophilic skin lesions. Read More

Dermatol Online J 2014 Apr 16;20(4):22373. Epub 2014 Apr 16.

Weil Cornell Medical College.

This article is dermatological atlas of the morphologic presentations of Hidradenitis Suppurativa (HS). It includes: superficial abscesses (boils, furnucles, carbuncles), abscesses that are subcutaneous and suprafascial, pyogenic granulomas, cysts, painful erythematous papules and plaques, folliculitis, open ulcerations, chronic sinuses, fistulas, sinus tracts, scrotal and genital lyphedema, dermal contractures, keloids (some that are still pitted with follicular ostia), scarring, skin tags, fibrosis, anal fissures, fistulas (i.e. Read More

J Adolesc Health 2014 Aug 13;55(2):304-6. Epub 2014 Apr 13.

Rheumatology Research Unit, Molecular Medicine Institute, Faculty of Medicine, Lisbon University, Lisbon, Portugal; Rheumatology Department, Hospital de Santa Maria, Lisbon, Portugal.

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes both dermatological and rheumatologic symptoms. Being a rare condition, the diagnosis is frequently late. The authors report a case of a 13-year-old boy diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with unusual severe systemic repercussions. Read More

Dermatol Online J 2014 Mar 17;20(3). Epub 2014 Mar 17.

Weil Cornell Medical College.

Although rare, severe hidradenitis suppurativa (HS) of the anal, perianal, gluteal, thigh, and groin regions can evolve into squamous cell carcinoma (SCC). This usually does not occur until the HS has been present for more than 20 years. Malignant degeneration of HS in the axilla has not been reported. Read More

Postepy Dermatol Alergol 2013 Dec 18;30(6):343-9. Epub 2013 Dec 18.

Department of General, Esthetic Dermatology and Dermatosurgery, Medical University of Lodz, Poland. Head: Prof. Grażyna Broniarczyk-Dyła MD, PhD.

Introduction: Treatment of the severe forms of acne vulgaris remains a challenge. Isotretinoin is a drug often used in these cases. Retinoids affect the mechanisms that play a role in the pathogenesis of acne, reduce the production of sebum and sizes of the sebaceous glands. Read More

Dermatology 2014 10;228(2):152-7. Epub 2013 Dec 10.

Department of Aesthetics and Cosmetology, School for Professions of Health and Welfare, Technological Educational Institute of Athens, Athens, Greece.

Background: The role of single-nucleotide polymorphisms (SNPs) of the TNF gene in acne vulgaris remains controversial.

Methods: Genomic DNA was isolated from 185 patients with acne vulgaris and 165 healthy controls. SNPs at positions -376, -308 and -238 of the promoter region of TNF were defined. Read More

J Formos Med Assoc 2015 Jun 1;114(6):562-4. Epub 2013 Nov 1.

Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Eur J Hum Genet 2014 Jun 9;22(6):741-7. Epub 2013 Oct 9.

1] Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Melbourne, VIC, Australia [2] Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.

Borrone Dermato-Cardio-Skeletal (BDCS) syndrome is a severe progressive autosomal recessive disorder characterized by coarse facies, thick skin, acne conglobata, dysmorphic facies, vertebral abnormalities and mitral valve prolapse. We identified a consanguineous kindred with a child clinically diagnosed with BDCS. Linkage analysis of this family (BDCS1) identified five regions homozygous by descent with a maximum LOD score of 1. Read More

JAMA Dermatol 2013 Nov;149(11):1306-7

Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.

Dermatol Online J 2013 Jun 15;19(6):18558. Epub 2013 Jun 15.

Weill Cornell Medical College, New York, NY, USA.

Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Read More

Photodermatol Photoimmunol Photomed 2013 Oct;29(5):233-8

Department of Dermatology, Lanzhou General Hospital of Lanzhou Military Area Command, Lanzhou, China.

Background: Acne conglobata is hardly curable and easily leads to scar formation after treatment using traditional methods.

Aim: To develop a novel way to treat acne conglobata.

Methods: Seventy-five patients with facial acne conglobata were included in this clinical study and divided into either a treatment group (n = 35) to receive photodynamic therapy (PDT) with topical 5% 5-aminolevulinic acid and red light once every 10 days for a month or a control group (n = 40) to receive a Chinese herbal medicine mask plus red light once per week for the same duration. Read More

Eplasty 2013 10;13:ic50. Epub 2013 Jul 10.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond.

Curr Rheumatol Rep 2013 Aug;15(8):346

Division of Rheumatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA.

To review and highlight the association of acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp with inflammatory arthritic conditions, we report five illustrative patients with this association, and a review of the literature. All our patients were African-American males, and their skin disease present before the onset of arthritis. Both asymmetric peripheral arthritis and axial disease can occur. Read More

J Clin Rheumatol 2012 Dec;18(8):413-5

Internal Medicine and Rheumatology Unit, Nuovo Regina Margherita Hospital, Rome, Italy.

We report the case of a patient with a simultaneous presence of pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis. This condition differs from both the PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis) syndrome, in which arthritis is absent, and the PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome, in which suppurative hidradenitis is lacking. Our patient failed to respond to etanercept therapy, whereas all dermatologic and rheumatic manifestations completely regressed following infliximab infusion. Read More

Hautarzt 2012 Apr;63(4):344-6

Dermatologische Praxis, Derma am Diako, Gröpelinger Heerstr. 406, 28329, Bremen, Deutschland.

In his autobiography, Charles Bukowski (1920-1994) describes his severe acne conglobata, his experience with therapy, family conflicts and emotional tension. Despite the stigmatization by his acne scars, Bukowski became a philobatic writer and a true chronist of the American way of life in the second half of the 20th century, writing in a coarse and obscene language. Read More

J Eur Acad Dermatol Venereol 2012 Dec 16;26(12):1538-43. Epub 2011 Nov 16.

Department of Aesthetics and Cosmetology, School for Professions of Health and Welfare, Technological Educational Institute of Athens, Athens, Greece.

Background: Former studies have shown that Propionibacterium acnes may stimulate expression of toll-like receptor 4 (TLR4) in keratinocytes of patients with acne vulgaris.

Objective: To investigate the impact of single nucleotide polumorphisms (SNPs) of the TLR4 gene in acne vulgaris.

Methods: Genomic DNA was isolated from 191 patients with acne vulgaris and 75 healthy controls. Read More

Am J Clin Dermatol 2012 Feb;13(1):55-9

Department of Internal Medicine and Specialist Sciences, Institute of Dermatology, A. Gemelli University Hospital, Catholic University, Rome, Italy.

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome defines an association of inflammatory cutaneous disorders with osteoarticular manifestations and represents a clinical and therapeutic challenge. We report a case of severe SAPHO syndrome with acne conglobata and a diffuse involvement of the anterior chest wall and sacroiliac joints that required treatment with isotretinoin and adalimumab, a new fully human anti-tumor necrosis factor (TNF)-α monoclonal antibody. Combination treatment determined a complete clinical remission of cutaneous and osteoarticular manifestations after 48 weeks. Read More

Indian J Dermatol 2011 May;56(3):318-20

Department of Dermatology and Venerology, Trakian University, Medical Faculty, Stara Zagora, Bulgaria.

Folliculitis et perifolliculitis capitis abscedens et suffodiens is a rare disease of unknown etiology. It is a suppurative process that involves the scalp, eventually resulting in extensive scarring and irreversible alopecia. The condition is also known as 'acne necrotica miliaris' or 'Proprionibacterium' folliculitis. Read More

J Am Acad Dermatol 2012 Mar 13;66(3):409-15. Epub 2011 Jul 13.

Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany.

Background: PAPA syndrome is a recently identified hereditary autoinflammatory syndrome clinically characterized by pyogenic arthritis, severe acne, and pyoderma gangrenosum. It is caused by mutations in the PSTPIP1 gene and may be closely linked to the aseptic abscesses syndrome, which has been shown to be associated with CCTG repeat amplification in the promoter region of PSTPIP1.

Objective: We describe two unrelated patients with a clinical presentation quite similar to, yet distinct from, PAPA syndrome. Read More

Acta Dermatovenerol Croat 2011 ;19(2):98-102

Department of Dermatology and Venereology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.

Perifolliculitis capitis abscedens et suffodiens or dissecting cellulitis of the scalp is a rare, chronic destructive folliculitis of the scalp, characterized by painful nodules, purulent drainage, sinus tracts, keloid formation and cicatricial alopecia. The cause of the disease is unknown, but it is similar in many features to hidradenitis suppurativa and acne conglobata. In our case report, the patient's dermatologic appearance included one slightly erythematous, infiltrated alopecic area with draining lesions in the right parietal part of the scalp with a few alopecic areas in other parts of the scalp. Read More

Acta Med Croatica 2010 Oct;64(4):247-51

Odjel za dermatovenerologiju, Kantonalna bolnica Dr. Irfan Ljubijankić, Bihać, Bosna i Hercegovina.

Objective: To determine the quality of life in adolescents with acne vulgaris in relation to the severity of clinical picture and sex using the Skindex-29 general questionnaire.

Patients And Methods: Using a sectional study, the quality of life was analyzed in 90 adolescents of both sexes, aged 16 to 21 years, who were suffering from acne vulgaris. The study was conducted between January 1, 2008 and January 31, 2009, at Department of Dermatovenereology, Dr. Read More

Wien Med Wochenschr 2011 Apr 25;161(7-8):204-8. Epub 2011 Jan 25.

Dermatologische Abteilung, Sozialmedizinische Zentrum Ost, Donauspital, Wien, Austria.

Painful, aseptic osteitis remains the major problem in the treatment of patients with SAPHO syndrome. We present a child suffering of both sacroiliitis and acne conglobata in the context of SAPHO syndrome. While acne lesions responded well to systemic isotretinoin, sacroiliitis associated pain could be controlled neither by NSAR nor by intralesional or systemic steroid injection. Read More

Actas Dermosifiliogr 2010 Jul;101(6):553-4

J Dtsch Dermatol Ges 2010 Jul;8 Suppl 2:s1-59

Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité- Universitätsmedizin Berlin, Berlin.

To optimize the treatment of acne in Germany, the German Society of Dermatology (DDG) and the Association of German Dermatologists (BVDD) initiated a project to develop consensus-based guidelines for the management of acne. The Acne Guidelines focus on induction therapy, maintenance therapy and treatment of post-acne scarring. They include an evaluation of the most commonly used therapeutic options in Germany. Read More

Rom J Morphol Embryol 2009 ;50(4):719-24

Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iassy, Romania.

Dissecting cellulitis of the scalp or dissecting folliculitis also known as "perifoliculitis capitis abscedens et suffodiens" (PCAS), is a rare, severe and distinct dermatological disease. It most probably occurs because of follicular occlusion via hyperkeratosis, having the same mechanism of acnea conglobata and hidradenitis suppurativa. These dermatoses may be associated or may have an isolated evolution. Read More

J Cutan Pathol 2010 Jan 25;37(1):49-58. Epub 2009 Aug 25.

Laboratory, Histopathology Division, King Fahd Hospital, Hofuf, Al-hassa, Saudi Arabia.

Background: Panniculitides are well-recognized clinicopathologic entities but the non-specificity of their clinical and pathological features often troubles the diagnostician.

Methods: This study retrospectively evaluates the clinical overlaps and the significance of histological findings among various panniculitides.

Results: The clinical evaluation in 55 panniculitides cases suggested the diagnosis of typical erythema nodosum (EN) in 26 cases, atypical EN in 17 cases, atypical nodular vasculitis (NV) in two cases, soft tissue infection in five cases and five cases remained unclassified. Read More

J Am Acad Dermatol 2010 May 7;62(5):861-3. Epub 2009 Aug 7.

College of Medicine, Medical University of South Carolina, Charleston, SC, USA.

Like other diseases of the follicular occlusion tetrad, acne conglobata can be difficult to treat. We describe the successful use of modern external beam radiation for acne conglobata in the case of a 53-year-old man with long-standing and disfiguring acne conglobata and hidradenitis suppurativa. For patients with severe acne conglobata resistant to more accepted therapies, modern external beam radiation may be a viable alternative on the therapeutic ladder. Read More

Zhen Ci Yan Jiu 2008 Dec;33(6):406-8

School of Aesthetic Medicine, Yichun College, Yichun 336000, China.

Objective: To observe the curative effect of acne conglobata treated by encircling acupuncture combined with ventouse and cupping.

Methods: A total of 52 acne conglobata patients were randomly divided into acupuncture group (n=26) and Western medicine group (n=26). Patients of acupuncture group were treated with encircling acupuncture around the affected focus. Read More

J Dermatol 2009 Feb;36(2):118-9

Acta Reumatol Port 2008 Jul-Sep;33(3):370-1

Serviço de Reumatologia do Centro Hospitalar do Alto Minho, Ponte de Lima.

Indian J Dermatol Venereol Leprol 2008 May-Jun;74(3):283-5