Acne conglobata (AC) is a disease attributed to an occlusion of sebaceous glands by a process of keratinization. This occlusion can be responsible for secondary sebaceous inflammation. Clinically, the patient presents with comedones, cysts, abscesses and draining sinus tracts, mainly located on the trunk and buttocks, but the face, neck and extremities may also be involved. In the literature, several cases of so-called AC may very well in fact be HS, such as in Whipp's two familial cases of fatal squamous cell carcinoma, in which a 56-year-old woman had suffered from "widespread abscesses predominantly affecting the buttocks, AXILLAE and back" . The question of an association between AC and HS arises. In contrast to HS, AC is predominant in men . It is however also highly inflammatory, starting in early adult life with an important tendency to scarring, which in AC is sometimes keloidal. Oral isotretinoin represents a major therapeutic improvement in the treatment of this once disfiguring disease. The drug is considerably more effective in clinical use than earlier drugs such as tetracyclines, but treatment requires high dosages of up to 2 mg/kg per day for months . Immunosuppressive therapy is also indicated when highly inflamed lesions are present. Malignant transformation into squamous cell carcinomas has been reported, similar to other long-standing inflammatory states of the skin such as ulcers .
Evidence for a possible causal association is however not strong, and epidemiological studies have failed to support a fixed relationship to cancer. Besides publications mentioning case reports of AC [4-15], it has been stated that it is quite common to find a medical history significant for acne vulgaris requiring isotretinoin in HS patients . The level of evidence is therefore at case-story level or lower. Unfortunately, even though isotretinoin can provide long-lasting remissions and possibly even cure AC, its efficiency against HS is usually minimal. Reports have suggested the efficacy of etretinate or acitretin on both HS and AC, but systematic evidence is lacking [13, 17-19]. However, even in these published cases a relapse of HS occurred between 4 months and a year after stopping ret-inoid treatment (see Chap. 17).
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