What is acne fulminans?
Acne fulminans is a rare and very severe form of acne conglobata associated with systemic symptoms. It nearly always affects males.
What are the clinical features of acne fulminans?
Acne fulminans 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)
The syndrome SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) may be a serious complication of acne fulminans.
What is the treatment for acne fulminans?
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 (2 g/day)
- Anti-inflammatory medications such as salicylates (aspirin)
- Systemic oral steroids such as prednisone (20-60 mg/day)
Topical acne medications are unhelpful.