Acne Fulminans Treatment & Management

Updated: Feb 08, 2019
  • Author: Ryszard Zaba, MD, PhD; Chief Editor: William D James, MD  more...
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Treatment

Oral Steroids and Isotretinoin

The recommended treatment for acne fulminans is a combination of oral steroids and isotretinoin. [18, 19, 20]

Oral steroids should be started and gradually reduced over 6 weeks to avoid the adverse effects of a prolonged course of systemic steroids. Some authors propose a shift with a 2-week corticosteroid treatment or 4 weeks of steroid treatment before starting isotretinoin. [21]

Isotretinoin should be started at 4 weeks, initially at 0.25 mg/kg daily and gradually increased to achieve complete clearance. Isotretinoin with a minimum total dose of 120 mg/kg is recommended. Relapses are rare. If required, a repeat course of isotretinoin (150 mg/kg) may be used.

Suicidal ideation, a concern in seemingly healthy adolescents, should be anticipated in those with cosmetically disturbing skin disorders, such as acne fulminans. Some believe that isotretinoin may exacerbate this tendency.

Some authors suggest treating patients with spontaneous development of acne fulminans with oral steroids and supplemental intralesional therapy.

The response to broad-spectrum antibiotic treatment is poor. Oral antibiotics yield a slow response in the resolution of acne and systemic symptoms. However, treatment with broad-spectrum systemic antibiotics including 300 mg clindamycin thrice daily and 750 mg levofloxacin daily in conjunction with 1 mg/kg/day oral prednisolone may be useful in some cases. [14] The combination of oral isotretinoin and systemic steroids is better than the combination of oral isotretinoin and antibiotics.

Infliximab, a monoclonal antibody against tumor necrosis factor-alpha, also may be a treatment option for patients with acne fulminans that is unresponsive to conventional therapies.

Other treatment

Friedlander reported that the pulsed dye laser is effective treatment for acne fulminans–associated granulation tissue. [22]

The addition of diaminodiphenylsulfone was effective for treating the relapse of acne fulminans in a patient with ulcerative colitis who was successfully treated with prednisolone. [23]

In some cases of acne fulminans, treatment with cyclosporine A and prednisolone may be also effective. [24]

A case of acne fulminans was successfully treated with oral prednisone and dapsone. [25]