Acne fulminans

  • Acne fulminans
    • A rare and severe destructive form of acne
    • Guidelines
    • Epidemiology
      • Mainly men (13-22 yo)
    • Clinical presentation
      • Sudden onset of febrile ulcerative necrotic acne lesions - numerous inflammatory tender and ulcerative nodules covered with haemorrhagic crusts
      • Most patients describe before mild to moderate acne for 0.5-5 years
      • Systemic signs and symptoms:
        • malaise, arthralgia, joint swellings, polyartheritis, myalgia, fever, anorexia, painful splenomegaly, erythema nodosum
        • osteolytic bone lesions
      • A subset of patients with no systemic symptoms
    • Predisposing factors: primarily in adolescent males (elevated blood levels of testosterone may play a role), anabolic androgenic steroids, use if isotretinoin as a trigger
    • The main differential diagnosis = severe acne conglobata
    • Associated diseases = SAPHO, PAPA syndromes
    • Treatment
      • Prednisolone 0,5-1mg/kg/dia for at least 2-4 weeks
      • Followed by initiation of low-dose isotretinoin (0,1mg/kg/dia) after the acute inflammation subsides
      • After 4 weeks, the dose of isotretinoin can be slowly increased and the prednisone taper
      • Adalimumab could be useful in management
      • Oral antibiotics generally of limited efficacy
      • IL-1 antagonists
      • Dapsone specially if erythema nodosum
      Evidence-based recommendations for the management of acne fulminans and its varians (JAAD)
      Evidence-based recommendations for the management of acne fulminans and its varians (JAAD)