Acne Fulminans Clinical Presentation

Updated: Jun 15, 2022
  • Author: Ryszard Zaba, MD, PhD; Chief Editor: William D James, MD  more...
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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. [18]

Bone pain related to aseptic osteolysis may be present. Acne fulminans with osteolytic changes in the metaphysis of the distal radius was also described. [19] 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. [20]

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


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 one joint or several joints, especially the hips, the knees, and the thighs.