Acne Fulminans Treatment & Management

Updated: Jun 06, 2016
  • 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. [17, 18, 19]

Oral steroids should be started and gradually reduced over 6 weeks to avoid adverse effects of a prolonged course of systemic steroids.

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 AF. 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 are responsible for a slow response in the resolution of acne and systemic symptoms. 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 AF that is unresponsive to conventional therapies.

Other treatment

Friedlander reported that the pulsed dye laser is effective treatment for acne fulminans–associated granulation tissue. [20]

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. [21]

In some cases of acne fulminans, treatment with cyclosporine A and prednisolone may be also effective. [22]

A case of acne fulminans was successfully treated with oral prednisone and dapsone. [23]