Acne fulminans with bone lesions

We present 5 young men who developed acne fulminans. During the acute, febrile illness, all had musculoskeletal symptoms, and X-ray and bone scan examinations revealed that 4 of the patients had osteolytic bone lesions. The disease was resistant to various antibiotics and one patient needed surgical trepanation of the sternum. No evidence of sepsis or bacterial osteomyelitis was found, as all bacteriological cultures proved negative and the tissue reaction was unspecific. The dermatopathogenetic origin of bone lesions in the present patients seems evident, but speculation that the etiology depends on immune mechanisms remains open.