Acne conglobata is a highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts.This condition generally begins between the ages of 18 and 30. It usually persists for a very long time, and often until the patient is around 40 years old. Although it often occurs where there is already an active acne problem, it can also happen to people whose acne has subsided. Although the cause of this type of acne is unknown, it is associated with testosterone and thus appears mainly in males. It can be caused by anabolic steroid abuse and sometimes appears in males after stopping testosterone therapy. It can also happen to someone who has a tumor that is releasing large amounts of androgens, or to people in remission from diseases, such as leukemia. In certain persons, the condition may be triggered by exposure to aromatic hydrocarbons or ingestion of halogens. Presentation
Acne conglobata is a severe, inflammatory variant of acne. Inflammatory papules, papulonodules, nodules and pustules may coalesce, and abscesses in the skin may form sinuses that interconnect. Bleeding or draining of acneiform plaques may be present. The systemic findings seen in acne fulminans are not present. A component of the follicular occlusion tetrad, acne conglobata may be seen with hidradenitis suppurativa, pilonidal disease and dissecting cellulitis of the scalp. The face, chest, back and buttocks may be involved. Treatment
The most common treatment is the acne medication isotretinoin. It may be combined with prednisone. Antibiotics such as dapsone, tetracycline or erythromycin may also be prescribed.
The North American Menopause Society (NAMS) 2016 annual meeting mentioned that HRT may have more benefits than risks in women before the age of 60.A consensus expert opinion published by The Endocrine Society stated that when taken during perimenopause or the initial years of menopause, HRT carries fewer risks than previously published, and reduces all cause mortality in most scenarios. The American Association of Clinical Endocrinologists (AACE) has also released position statements approving of HRT when appropriate.Women receiving this treatment are usually post-, peri-, or surgically menopausal. Menopause is the permanent cessation of menstruation resulting from loss of ovarian follicular activity, defined as beginning twelve months after the final natural menstrual cycle. This twelve month time point divides menopause into early and late transition periods known as perimenopause and postmenopause. Premature menopause can occur if the ovaries are surgically removed, as can be done to treat ovarian or uterine cancer. Demographically, the vast majority of data available is in postmenopausal American women with concurrent pre-existing conditions and an average age of over 60 years. Menopausal symptoms
HRT is often given as a short-term relief from menopausal symptoms during perimenopause.