聚合型痤疮怎么办？：症状及治疗一览

聚合型痤疮是一种非常严重但相当罕见的炎性痤疮形式。 它导致大的炎症性丘疹，脓疱和深在性结节。 结节大且通常呈圆顶状。 顶端皮肤破溃后经常会分泌难闻的脓液。
聚合型痤疮与更常见的结节囊肿性痤疮的区别在于聚合型痤疮的深在性含有脓液的结节向皮肤深处生长、扩散，并且相互贯通形成窦道。

那么，聚合型痤疮的临床表现和治疗是怎样的？让我们一起往下看吧～

Acne conglobata is a very severe, but fairly rare, form of inflammatory acne. Acne conglobata causes large inflammatory pimples, papules, and deep nodules.  Nodules grow very large and are often dome-shaped. Breakouts often drain bad-smelling pus.
What separates acne conglobata from the more common nodulocystic acne is that acne conglobata causes large draining abscesses. These  deep breakouts grow and spread beneath the skin's surface, then join up with each other, forming sinus tracts.

What are the symptoms and treatments for acne conglobata? Let's check it out together~

示例：聚合性痤疮

examples: acne conglobata

01

聚合型痤疮的临床表现是怎样的？（What are the symptoms of acne conglobata？）

                                        

聚合型痤疮通常发生在背部和胸部，肩部，大腿和臀部，以及面部。当它们在皮肤下生长和互相贯通时，可见线性皮损，而不是单一的圆形皮损。有一些关键点可以帮助区分聚合型痤疮与更常见的结节囊肿性痤疮（通常称为囊肿性痤疮）的严重病例。
一个是黑头出现的方式。显然，黑头是非常普遍的，几乎每个人都能有黑头，即使没有痤疮的人也可以有。通常黑头是单发的，然而在聚合型痤疮中，黑头几乎总是两个或三个成组出线。它们会发炎并长成大而疼痛的结节。
黑头和其他非发炎的粉刺（也称为毛孔堵塞）也可以长得非常大，最大直径可达3厘米。这些大的毛孔堵塞称为“巨型粉刺”。
当痤疮皮损破溃后愈合时，皮损中央结痂。而聚合型痤疮结节破溃后聚合非常缓慢，即使中央结痂，炎症仍会继续向外扩散。

Acne conglobata typically occurs on the back and chest, shoulders, thighs, and buttocks, as well as the face. You'll get lines of breakouts, rather than single blemishes, as they grow and interconnect beneath the skin. There are a few key distinctions that can help differentiate acne conglobata from severe cases of the more common nodulocystic acne (often called cystic acne).
One is the way that blackheads develop. Blackheads, obviously, are incredibly common and nearly everyone gets them, even people without acne. Whereas, typically, blackheads appear singularly, in acne conglobata blackheads nearly always appear in groups of two or three. These become inflamed and grow to large, painful nodules.
Blackheads and other non-inflamed comedones (aka pore blockages) can grow really large as well, up to 3 centimeters across. These large pore blockages are called "macrocomedones."
As the skin tries to heal, a scab forms in the middle of the blemish. Acne conglobata nodules are notoriously slow healers and continue to spread outward even as the scab develops in the middle of the breakout.

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02

聚合型痤疮的治疗方法有哪些？（What are the treatments for acne conglobata？）

聚合型痤疮的治疗是一个挑战。这种类型的痤疮必须由皮肤科医生治疗。系统性异维A酸是目前最常用的治疗方法，通常是第一种治疗方法。
口服抗生素是另一种常见的治疗选择。它们可以联合或在异维A酸停药过程后使用，不能口服异维A酸的患者也可用抗生素替代。
通常可用四环素、米诺环素和多西环素（不能与异维A酸联用）。克拉霉素可与异维A酸联用。
像泼尼松这样的口服糖皮质激素也可用于帮助减轻炎症，但不能长期服用。免疫抑制药物英夫利昔单抗也可能带来改善。

Acne conglobata is challenging to treat. This type of acne absolutely must be treated by a dermatologist. Isotretinoin is by far the most common treatment and is generally the first treatment prescribed.
Oral antibiotics are another common treatment choice. They may be used in combination with or after the course of isotretinoin has stopped, or in place of isotretinoin if that medication can't be used.
Tetracycline, minocycline, and doxycycline are generally prescribed (cannot be used with isotretinoin). Clarithromycin can be used in combination with isotretinoin.

Oral steroids like prednisone may also be prescribed to help reduce inflammation. There are some reports of improvement with the immunosupressive medication infliximab.

如果口服和外用药物没有好转，下一步就是尝试手术+光动力治疗。先通过手术引流结节中的脓液，并在皮损表面破口，以促进光敏剂的吸收。之后在痤疮部位敷含有光敏剂的溶液。经过1-2小时敷药，光敏剂被皮肤吸收，富集于炎性的毛囊皮脂腺中。再通过照光激活光敏剂，于组织中的氧反应，产生自由基杀伤病变细胞。

If cne conglobata is not getting any better after systematic and topical treatments, the next step is surgery in combination with photodynamic therapy. Firstly, we drain and make small incisions on the lesions to enhance the absorption of photo-sensitizer. Then we incubate the lesions with liquid containing photo-sensitizers. After 1-2 h of incubation, the photo-sensitizer gets absorbed in the skin and specificly accumulate in the inflammed sebaceous glands. Next the lesions are exposed to light source. Photo-sensitizer is activated by the light and reacts with tissue oxygen, producing free radicals to kill inflammed cells.

通常进行3-5次光动力治疗后皮损可完全清除，并且很少复发。下面展示1例经我团队2次光动力治疗的聚合型痤疮案例。

Complete clearance of lesions can be achieved normally after 3-5 sessions of photpdynamic therapy. And relapse is very rare. Here is one of our case after 2 sessions of phtodynamic therapy.

由于聚合型痤疮可以快速发展，关键要尽早进行治疗。由于聚合型痤疮对皮肤的结构造成极大的伤害，它几乎总会留下疤痕。控制症状是当务之急。一旦痤疮得到合理控制，您和您的皮肤科医生就可以开始讨论疤痕治疗方案。
The key is to get treatment early; acne conglobata can spread quickly. Since acne conglobata does extreme damage to the skin's structure, it almost always leaves scarring, unfortunately. Getting the nodules under control is the pressing goal. Once acne is reasonably controlled, you and your dermatologist can start talking about scar treatment options.