Treating refractory acne conglobata with secukinumab: A case report

Acne conglobata (AC) is a rare subtype of acne with disfiguring manifestations such as aggregated acne, papules, pustules, abscesses, and interconnected draining sinus tracts. Currently, there are successful off-label uses of secukinumab in treating diseases including hidradenitis suppurativa, which is very similar to AC.1, 2 Here, we report a case of successful treatment of AC with secukinumab, which is refractory to routine treatments. A 21-year-old man presented with red papules and pustules on the face and neck for 2 years, aggravated with cysts and sinus tracts over 3 months. Three months before he came to the clinic, many red papules, pustules, cysts, and sinus tracts appeared on his face and neck without an obvious cause, with localized painful tenderness and sleep disorder at night. Oral minocycline (50 mg/d) and isotretinoin (20 mg/d) in combination with topical adapalene and benzoyl peroxide at the onset of symptoms for 3 months did not result in any improvements. Then, adalimumab intramuscularly twice in 2 weeks (80 mg, 40 mg) was trialed but helped insignificantly (Figure 1a). The diagnosis of AC was made according to International Classification of Diseases, Tenth Revision (ICD-10), which was unresponsive to conventional acne treatment and anti-tumor necrosis factor (TNF) therapies. The patient was treated with secukinumab 300 mg once a week for five times and every 4 weeks thereafter combined with other routine treatments (topical adapalene and benzoyl peroxide). Two weeks later, a marked decrease in the pustules and cysts was observed. The lesions completely resolved after 8 weeks of treatment, and Echelle de Cotation des Lésions d'Acné, Global Acne Severity Scale, and pain visual analog scale scores also decreased significantly (20 vs 6, 5 vs 2, and 9 vs 0, respectively). After the induction treatment in the first month and the monthly use of secukinumab in the following 3 months, the patient discontinued the drug for 5 months until now without recurrence (Figure 1a,b). AC is a rare, severe, and highly inflammatory form of acne vulgaris. No other effective alternatives are available for patients with poor response to retinoids. Previous case reports indicated that TNF-α blockers are effective in controlling AC.3 However, TNF-α blockers did not help the patient in our case. As for the signaling pathways underlying AC pathogenesis, Hanna et al. demonstrated that interleukin (IL) 17A+T cells lead to the production of cytokines such as TNF-α, IL-1β, IL-6, and IL-8 in acne lesions.4 Thus, the Th17/IL-17 pathway likely participates in the pathogenesis of AC, which might be a novel therapeutic target. Recently, Bocquet et al.5 found that secukinumab might be helpful in acne fulminans caused by isotretinoin. Therefore, we attempted to use the anti-IL-17A monoclonal antibody secukinumab to treat this patient with AC. Here, we present an unusual case of AC that was resistant to routine treatment and TNF-α blockers but responded well to secukinumab. According to our knowledge, treating AC with secukinumab has not previously been reported. The results also indicate that investigating the effect of anti-IL-17 therapy on AC and similar diseases in a formal trial might be meaningful. No funding was secured for this study. None declared.