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Acne Fulminans Clinical Presentation

  • Author: Ryszard Zaba, MD, PhD; Chief Editor: William D James, MD  more...
 
Updated: Jun 06, 2016
 

History

The primary features of this disease include the following:

  • Sudden onset
  • Severe and often ulcerating acne
  • Fever and polyarthritis
  • Failure to respond to antibacterial therapy
  • Good response to oral steroid therapy, after 4-6 weeks, the addition of oral isotretinoin

Acne fulminans predominantly affects young males with a history of acne.

Painful splenomegaly and erythema nodosum may be present.[14]

Bone pain related to aseptic osteolysis may be present. Acne fulminans with osteolytic changes in the metaphysis of the distal radius was also described.[15] Gordon et al report a case of a 13-year-old boy with severe acne and multiple osteolytic bone lesions who presented to pediatric oncologists; the patient avoided unnecessary painful diagnostic procedures when it was recognized he had acne fulminans.[16]

Patients with acne fulminans and acneiform folliculitis may have chronic aseptic multifocal osteomyelitis.

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Physical Examination

Acne fulminans (similar to acne conglobata) demonstrates numerous inflammatory nodules on the trunk. In acne fulminans, the large nodules tend to become painful ulcers with overhanging borders surrounding exudative necrotic plaques that become confluent; however, polyporous comedones and noninflammatory cysts are not evident (as seen in acne conglobata). Erythematous neovascular nodules may also be seen.

Acne fulminans is a systemic disease. Patients may demonstrate a bent-over posture because polyarthritis may make walking painful.

Inflammatory arthralgia may affect 1 joint or several joints, especially the hips, the knees, and the thighs.

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Causes

See Pathophysiology.

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Contributor Information and Disclosures
Author

Ryszard Zaba, MD, PhD Professor, Department of Dermatology and Venereology, Poznan University School of Medical Sciences, Poland

Ryszard Zaba, MD, PhD is a member of the following medical societies: Sigma Xi, European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

References
  1. Burns RE, Colville JM. Acne conglobata with septicemia. Arch Dermatol. 1959. 79:361-3.

  2. Windom RE, Sanford JP, Ziff M. Acne conglobata and arthritis. Arthritis Rheum. 1961 Dec. 4:632-5. [Medline].

  3. Iqbal M, Kolodney MS. Acne fulminans with synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome treated with infliximab. J Am Acad Dermatol. 2005 May. 52(5 Suppl 1):S118-20. [Medline].

  4. Kraus SL, Emmert S, Schön MP, Haenssle HA. The dark side of beauty: acne fulminans induced by anabolic steroids in a male bodybuilder. Arch Dermatol. Oct 2012. 148(10):1210-2.

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  9. Palatsi R, Oikarinen A. Hormonal analysis and delayed hypersensitivity reactions in identical twins with severe acne. Acta Derm Venereol. 1979. 59(2):157-60. [Medline].

  10. Placzek M, Degitz K, Schmidt H, Plewig G. Acne fulminans in late-onset congenital adrenal hyperplasia. Lancet. 1999 Aug 28. 354(9180):739-40. [Medline].

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  12. Brănişteanu DE, Cotrutz CE, Luca MC, Molodoi DA, Stoica LE, Ianoşi SL, et al. Morphopathological stigmata in acne fulminans. Rom J Morphol Embryol. 2015. 56 (3):1185-90. [Medline].

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  14. Williamson DM, Cunliffe WJ, Gatecliff M, Scott DG. Acute ulcerative acne conglobata (acne fulminans) with erythema nodosum. Clin Exp Dermatol. 1977 Dec. 2(4):351-4. [Medline].

  15. Kim SY, Jung SK, Lee SG, Yi SM, Kim JH, Kim IH. Acne fulminans with osteolytic change in metaphysis of distal radius. Int J Dermatol. 2016 May. 55 (5):571-3. [Medline].

  16. Gordon PM, Farr PM, Milligan A. Acne fulminans and bone lesions may present to other specialties. Pediatr Dermatol. 1997 Nov-Dec. 14(6):446-8. [Medline].

  17. Allison MA, Dunn CL, Person DA. Acne fulminans treated with isotretinoin and "pulse" corticosteroids. Pediatr Dermatol. 1997 Jan-Feb. 14(1):39-42. [Medline].

  18. Leyden JJ. The role of isotretinoin in the treatment of acne: personal observations. J Am Acad Dermatol. 1998 Aug. 39(2 Pt 3):S45-9. [Medline].

  19. Seukeran DC, Cunliffe WJ. The treatment of acne fulminans: a review of 25 cases. Br J Dermatol. 1999 Aug. 141(2):307-9. [Medline].

  20. Friedlander SF. Effective treatment of acne fulminans-associated granulation tissue with the pulsed dye laser. Pediatr Dermatol. 1998 Sep-Oct. 15(5):396-8. [Medline].

  21. Wakabayashi M, Fujimoto N, Uenishi T, Danno K, Tanaka T. A case of acne fulminans in a patient with ulcerative colitis successfully treated with prednisolone and diaminodiphenylsulfone: a literature review of acne fulminans, rosacea fulminans and neutrophilic dermatoses occurring in the setting of inflammatory bowel disease. Dermatology. 2011. 222(3):231-5. [Medline].

  22. Tago O, Nagai Y, Matsushima Y, Ishikawa O. A case of acne fulminans successfully treated with cyclosporin a and prednisolone. Acta Derm Venereol. May 2011. 91(3):337-8.

  23. Lages RB, Bona SH, Silva FV, Gomes AK, Campelo V. Acne fulminans successfully treated with prednisone and dapsone. An Bras Dermatol. Jul-Aug 2012. 87(4:612-4. [Medline].

  24. [Guideline] Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May. 74 (5):945-973.e33. [Medline].

  25. [Guideline] American Academy of Dermatology. Ten Things Physicians and Patients Should Question. Choosing Wisely. Available at http://www.choosingwisely.org/societies/american-academy-of-dermatology/. August 19, 2015; Accessed: : April 30, 2016.

  26. Champion RH, Burton JL, Burns DA, Breathnach SM, eds. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. Oxford, England: Blackwell Science; 1998. 1967-79.

  27. Cunliffe WJ, Gollnick H. Acne fulminans. Cunliffe WJ, Gollnick H. Acne. Diagnosis and Management. London, England: Martin Dunitz Ltd; 2001. 84-6.

 
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