SKINIPEDIA - Skin Encyclopedia: Acne Conglobata Carcinoma

Epidermoid Carcinoma Occurring in Acne Conglobata by John S. Dillon, M.D., Harlan J. Spjut, M.D.

Source: the Departments of Surgery and Surgical Pathology, Washington University School of Medicine, and Barnes Hospital, St. Louiis, Mlissouiri

ACNE CONGLOBATA, a severe form of chronic acne, was first described by Spitzer," in 1903, as "Dermatitis Follicularis
et Perifollicularis Conglobata." A variant of it, "Acne Aggregata Seu Conglobata," in which the lesions communicate with one another by fistulae was described by Reitmann, in 1908. Since then, reports concerning this relatively rare dermatitis have been few, being case reports, bacteriologic sttudies and discussions of its resemblance to cutaneous tuberculosis. The best description of it is that of Michelson and Allen.

Although Selisky believed acne conglobata to be merely an extreme form of acne occurring in patients of the so-called seborrheic type, several features serve to distinguish it from acne vulgaris. Acne conglobata is practically an affliction of men only, beginning during late puberty and continuing throughout life. At times it appears to be familial. It may affect any part of the body, but especially the hairiest parts such as the chest, shoulders and back.

The disease starts with the appearance of comedones that are accompanied by inflammation. Large papules, or papulo-pustules and, at times, large sebaceous retention cvsts, are subsequently generated. The disease proceeds indolently, forming expanding elevated plaques of inflammation in which abscesses develop and rupture. The abscesses may coalesce forming serpiginous spreading ulcers. Frequently the ulcers communicate with one another subcutaneously forming cutaneous fistulas. Whenever the ulcers do heal, they form pitted, irregular keloid scars, the so-called bridge scars of Lang. These scars often enclose sebaceous cysts, comedones, or pustules. Usually all of the various stages of the lesions are to be found interspersed. Hyperkeratosis of hair follicles and the epidermal surface, attenuation of the rete ridges, near absence of the granular cell layer epidermal cornified whorls and keratotic cysts characterize the individual lesions.

Excision of the severely afflicted skin and covering the cutaneous defects with split skin grafts is the only effective
treatment known. Irradiation and antibiotics have failed to control the disease.

If chronicity of inflammation promotes or generates neoplasia, acne aggregata seu conglobata should be associated more than rarely with cutaneous carcinoma. One case of epidermoid carcinoma associated with acne conglobata has been reported. Another, ambiguously described as epithelionza, may have been epidermoid carcinoma associated with acne conglobata. During the past ten years, two patients have been seen at Barnes Hospital with squamous cell carcinoma located in regions of extensive involvement with acne seu conglobata.

Case Reports on Acne Conglobata are HERE.

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