Acne fulminans

Acne fulminans is a rare and very severe form of acne conglobata associated with systemic symptoms. It nearly always affects males.

Acne fulminans

Clinical features

It is characterised by:

• Abrupt onset
• Inflammatory and ulcerated nodular acne on chest and back
• Severe acne scarring
• Fluctuating fever
• Painful joints
• Malaise (ie. the patient feels unwell)
• Loss of appetite and weight loss
• Raised white blood cell count.

Although it mostly just happens, it may be precipitated by:

• Testosterone (legally prescribed or illegally taken to enhance muscle growth)
• Isotretinoin

The syndrome SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) may be a serious complication of acne fulminans.

Management

Patients with acne fulminans should consult a dermatologist urgently. Management can prove difficult, and several medications are usually required. These may include:

• High doses of oral antibiotics such as erythromycin (2g/day)
• Anti-inflammatory medications such as salicylates (aspirin)
• Systemic oral steroids such as prednisone (20-60mg/day)
• Dapsone
• Isotretinoin

Topical acne medications are unhelpful.