The primary and most effective treatment for acne conglobata is oral isotretinoin, typically administered at doses of 0.5 to 1 mg/kg/day for around 15 to 28 weeks or longer, depending on the case. Oral prednisone (1 mg/kg/day) may be added for 14 to 28 days when starting isotretinoin to manage inflammation and potential flares. For patients who experience acne fulminans (a severe reaction to isotretinoin), isotretinoin should be paused, and prednisone should be used before restarting isotretinoin at a lower dose. Additional treatment options include oral antibiotics such as tetracyclines (minocycline or doxycycline), though these should not be combined with isotretinoin due to risks. Dapsone is another option when patients are unresponsive to other treatments, but it requires careful monitoring. In some cases, TNF-alpha inhibitors and laser therapies have been used successfully. Surgical options, such as aspiration, cryotherapy, intralesional corticosteroids, and excision of large nodules, may be necessary. For scarring, dermal fillers and skin grafting can improve appearance. Topical treatments alone are usually not sufficient but may be used as adjuncts to oral therapy. Hormonal therapy may be considered, especially in women with hormonal imbalances. Psychological support and lifestyle management, including stress reduction and skin care routines, are important adjuncts to medical treatments. Overall, treatment requires a comprehensive approach with dermatological supervision due to the severity and complexity of acne conglobata and its potential for scarring and systemic symptoms.