The treatment of acne fulminans: a review of 25 cases

The treatment of acne fulminans has been difficult. It is difficult to perform a controlled treatment trial due to the rarity of the complication. However, it is possible to compare four different therapeutic regimens which have evolved with time in the management of 25 patients over a period of 25 years. Oral antibiotics produced a slow response in the resolution of acne and systemic symptoms. The addition of a systemic steroid produced a quick resolution of systemic features, but the time until resolution of the acne was longer than when it was used in combination with oral isotretinoin. The protocols which used a combination of prednisolone and isotretinoin led to faster control of systemic features as well as clearance of acne when compared with other protocols. This was particularly so if the oral steroid was used sooner rather than later. We conclude that the preferred treatment of acne fulminans is oral prednisolone 0.5-1 mg/kg daily for 4-6 weeks (thereafter slowly reduced to zero) with oral isotretinoin being added to the regimen at the fourth week, initially at 0.5 mg/kg daily and gradually increased to achieve complete clearance.     

Bone lesions in systemic acne (acne fulminans)

An 18-year-old West Indian male presented with severe sternal pain and an exacerbation of facial acne. Radiographs of the sternum revealed several lytic lesions which appeared as hot areas on successive technetium bone scans. Painful areas over the right iliac crest and left greater trochanter likewise appeared as transient hot areas on successive scans. Histology of affected bone revealed reactive changes only. High dose prednisolone provided rapid alleviation of pain, which recurred on reducing the dose to less than 10 mg daily. Auto-immune complex disease has been considered the most likely aetiological mechanism of systemic acne (acne fulminans), but lytic lesions of bone have never previously been reported in auto-immune disorders.     

Pseudo-acne fulminans associated with oral isotretinoin

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation.     

ANCA-positive vasculitis of the skin and kidneys associated with acne conglobata

A 19 year old man with severe acne conglobata and ulcerated pyoderma gangraenosum-like skin lesions on the face was first treated with isotretinoin (Roaccutan((R))), then immunosuppressively with prednisolone, diaminodiphenylsulfone (Dapson-Fatol((R))) and mycophenolate mofetil (Cellcept((R))). Under a daily maintenance dose of immunosuppressive treatment with 2.5 mg prednisolone and 1 g mycophenolate mofetil, weakness, muscle and joint aches appeared. Due to proteinuria, haematuria and an elevated antineutrophil cytoplasmic antibody (cANCA) and the histological detection of a leukocytoclastic vasculitis, the diagnosis of cANCA positive vasculitis of the skin and kidneys was established. Therapy with cyclophosphamide (Endoxan((R))) along with prednisolone was effective. An exact classification of this disease process was not possible.     

暴发性痤疮1例

患者，男性，20岁，痤疮病史3年，近40天面部，躯干，上肢急性发作炎性丘疹，结节及脓疱，皮疹可融合，形成糜烂，溃疡，伴有发热，食欲不振，关节肌肉疼痛，白细胞总数增多，单纯抗生素治疗无效，口服异维A酸及短期皮质类固醇，配合阿齐霉素等抗生素治疗，4个月后患者完全治愈。     

Acne fulminans successfully treated with prednisone and dapsone

Acne fulminans is a rare condition and the most severe form of acne. It involves the sudden onset of febrile and multisystemic symptoms, with poor response to ordinary therapy in patients who previously had mild to moderate acne. It is characterized by hemorrhagic ulcerative crusting lesions on the face, chest and upper back. The authors report a case of acne fulminans that was successfully treated with oral prednisone and dapsone.     

Acne fulminans: investigation of acute febrile ulcerative acne.

Eight cases of acne fulminans (acute febrile ulcerative acne) are compared with 13 previously reported cases. This rare disorder of male teenage patients is characterized by the sudden appearance of highly inflammatory, tender, ulcerative and crusted lesions on the back, chest, and face: it is one of the most scarring acute dermatologic disorders of young patients. At the onset of the disease, all patients showed febrile temperatures and marked leukocytosis; other systemic symptoms occurred with varying frequency. Polyarthralgia was noted in half of our series. Investigations of potential trigger mechanisms (eg, septisemia due to Corynebacterium acnes, immunologic defects, altered polymorphonuclear leukocyte function, Shwartzman phenomenon) did not yield any clues regarding the pathogenesis of this disease. Clinical and laboratory findings suggest that acne fulminans is not directly related to acne conglobata.     

Acne fulminans concomitant with vasculitis-like symptoms mimicking Henoch-Schoenlein purpura

Acne fulminans is a severe form of acne vulgaris accompanied by systemic symptoms. A 17-year-old Chinese boy presented with an outbreak of necrotic lesions on his face eight days after the onset of palpable purpura, arthralgia, fever, abdominal pain, and proteinuria. He was successfully treated with oral prednisolone and isotretinoin. Vasculitis-like symptoms are rarely reported in acne fulminans; therefore, the physician needs to maintain awareness of this uncommon presentation.     

Familial acne fulminans

We report a patient of acne fulminans with arthralgia whose sister presented with the same disease at an identical age 10 years earlier. The two affected siblings in our family also had identical HLA phenotypes which further supported the role of genetic susceptibility in acne fulminans.     

Acne fulminans

Acne fulminans is a syndrome of fulminant, necrotizing acne associated with bone lesions, constitutional symptoms, and laboratory abnormalities. A case report of an adolescent male with acne fulminans following withdrawal of isotretinoin and prednisone is presented.     

罕见暴发性痤疮并发混合型过敏性紫癜患者1例护理

 对1例暴发性痤疮并发混合型过敏性紫癜患者颜面部脓疱、皮肤紫癜情况采取针对性护理,通过皮损护理、饮食管理、心理护理和健康指导进行前瞻性护理干预。经治疗及护理,患者面部痤疮控制、糜烂面愈合,皮肤紫癜消退,住院16 d,病情好转出院。     

Facial Sweet's syndrome mimicking rosacea fulminans

A 36-year-old man presented with a non-pruritic, erythematous facial rash with peri-oral and peri-orbital sparing. The initial clinicopathological diagnosis was rosacea fulminans, which was treated with 25 mg oral prednisolone and cephalexin. The patient re-presented 1 week later with exacerbation of his rash in addition to constitutional symptoms of fever and malaise. A further skin biopsy was taken and the marked neutrophilic infiltrate in the absence of vasculitis made the diagnosis of Sweet's syndrome (acute febrile neutrophilic dermatosis). High-dose prednisolone (50 mg daily), topical hydrocortisone cream and ichthammol in zinc ointment were commenced with rapid clinical improvement. This case highlights the importance of considering Sweet's syndrome as a differential diagnosis when presented with a facial eruption.     

Acne fulminans and 13-cis-retinoic acid.

We report a case of acne fulminans occurring during treatment with 13-cis-retinoic acid for cystic acne. Continuing the treatment with 13-cis-retinoic acid without systemic steroid eventually cleared the systemic manifestations and skin lesions. We review the literature and discuss its pathogenesis.     

Acne fulminans associated with inflammatory bowel disease. Report of a case

Several reports of acne fulminans (acute febrile ulcerative acne) have described associated musculoskeletal manifestations. We report herein a case of this rare disorder that occurred simultaneously with the onset of Crohn's disease.     

Rosacea fulminans in a patient with Crohn's disease: a case report and review of the literature

Rosacea fulminans is a rare disorder of unknown cause that mainly affects postadolescent women, with abrupt onset and disfiguring course if left untreated. The simultaneous occurrence of rosacea fulminans and inflammatory bowel disease is rare and has been reported predominantly in the setting of ulcerative colitis. We describe here a case of rosacea fulminans in a patient with Crohn's disease and discuss a possible association between the two conditions.     

Acne fulminans triggered by isotretinoin therapy]

An 18-year old male patients with tetracycline-resistant acne vulgaris was prescribed isotretinoin in daily doses of 0.5 mg/kg. Ten days later, he developed an acute episode of acne fulminans which was regressive. Subsequently, two attempts were made at reintroducing isotretinoin; the first one was followed by a new episode of acne fulminans and the second one, by ordinary myalgias, while the patient was still under corticosteroid therapy. A search in the literature yielded 14 cases of acne fulminans that had possibly been induced by isotretinoin. Doses and intervals between medication and acute manifestations varied, and the responsibility of isotretinoin was seldom demonstrated. Associations with erythema nodosum myalgias and arthralgias have been described. This rare adverse effect of isotretinoin therapy must be known. Its course and treatment are not different from those of ordinary acne fulminans.     

Levamisole treatment of acne fulminans (author's transl)

In two young patients levamisole 150 mg twice weekly led to a rapid and long-lasting improvement of their acne fulminans. The sudden deterioration of acne vulgaris leading to acne fulminans is possibly due to a temporary immunodepression.     

Fulminant acne: therapy with 13-cis-retinoic acid and indomethacin

Young men with mild acne vulgaris may rarely experience a very acute exacerbation with ulceration and necrosis of the lesions accompanied by fever, malaise, loss of weight, often by polyarthritis, and occasionally by erythema nodosum. Elevated sedimentation rate and marked leucocytosis are characteristic; microhematuria is often observed. This condition has been called acne fulminans. We report on a young male patient suffering from severe acne fulminans. Systemic 13-cis retinoic acid (Roaccutan, Accutane) and indomethacine (Amuno) treatment rapidly improved the skin and joint lesions. Intracutaneous tests with viral, bacterial, and fungal antigens before and during treatment suggest a temporary cellular immune defect.     

Acute ulcerative acne conglobata (acne fulminans) with erythema nodosum

A patient with acute ulcerative acne conglobata developed erythema nodosum which resolved as the acne improved. Skin testing with P. acne antigen produced an Arthus-type phenomenon supporting the hypothesis that the erythema nodosum could have been a similar reaction related to the severe acne vulgaris     

Acne fulminans 'sine fulminans'

Acne fulminans is characterized by the sudden onset of a severe, ulcerative acne associated with systemic features. Response to traditional acne therapies is poor. We have recognized a subset of patients with acne of a severity comparable to that of acne fulminans but with the absence of systemic involvement; we suggest modification of the treatment regimes used in this group.