SERONEGATIVE ARTHRITIS (MA KHAN, SECTION EDITOR) Spondyloarthritis Associated with Acne Conglobata, Hidradenitis Suppurativa and Dissecting Cellulitis of the Scalp: A Review with Illustrative Cases Debbie T. Lim & Neena M. James & Sobia Hassan & Muhammad A. Khan # Springer Science+Business Media New York 2013 Abstract To review and highlight the association of acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp with inflammatory arthritic conditions, we report five illustrative patients with this association, and a review of the literature. All our patients were African-American males, and their skin disease present before the onset of arthritis. Both asymmetric peripheral arthritis and axial disease can occur. The arthritis is usually insidious and lacks association with rheumatoid factor and HLA-B27. Imaging of peripheral joints can reveal erosions, periosteal bone reaction and new bone formation. When the axial skeleton is involved, imaging can reveal sacroiliitis, syndesmophyte formation. NSAIDs, oral and intra-articular steroids, DMARDs and TNF alpha antagonists have all been used with success. Controlled trials with larger numbers of patients are needed to assess which treatment options are the most effective for this group of patients. Keywords Ankylosing spondylitis . Sacroiliitis . Spondyloarthropathy . Seronegative arthritis . Treatment . TNF-inhibitors . HLA-B27 . Acne conglobata . Hidradenitis suppurativa . Dissecting cellulitis of the scalp . Inflammatory arthritic Introduction Dermatological diseases that show an association with seronegative inflammatory arthritis but are under-recognized and inadequately managed include: acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp [1–15, 16•, 17••, 18]. In this review, we first briefly describe the dermatologic manifestations of these diseases, and provide five illustrative case reports of the patients encountered at our center to highlight the clinical spectrum of the associated inflammatory arthritis. This is followed by the description of the clinical, laboratory and radiographic findings of the associated inflammatory arthritis and its management. Acne Conglobata Acne conglobata is a highly inflammatory form of acne which usually presents as numerous comedones, nodules, papules, pustules, interconnecting abscesses and draining sinus tracts with associated scarring of the skin. Deep ulcers may form beneath the nodules leading to keloid-type scars. Occasionally, acne conglobata may develop in the setting of acne vulgaris that had been dormant for many years [19]. The lesions are usually found on the face, neck, chest, upper arms, buttocks and thighs. It is most common in teenage males but can occur in either sex and into adulthood [20]. This condition is different from acne fulminans, the most severe form of nodular acne, which is often classified with acne conglobata in the medical literature. Initially, the disease resembles acne conglobata with numerous lesions on the back and chest, although the neck and face are invariably spared. The distinguishing morphologic feature is the formation of hemorrhagic nodules and plaques which later ulcerate [21]. The onset of acne fulminans is more explosive, nodules and comedones are less common, ulcerative and crusted lesions are unique, and systemic symptoms such as fever, leukocytosis, polyarthralgia, myalgia, hepatosplenomegaly, and anemia are more This article is part of the Topical Collection on Seronegative Arthritis D. T. Lim : N. M. James : S. Hassan : M. A. Khan (*) Division of Rheumatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA e-mail: mkhan@metrohealth.org Curr Rheumatol Rep (2013) 15:346 DOI 10.1007/s11926-013-0346-y