Acne Fulminans: Treatment Experience from 26 Patients

Abstract

Background /Aim: Acne fulminans is a rare form of acne vulgaris with acute clinical deterioration including systemic signs. Etiopathogenesis and management remain largely unknown. Our aim is to assess the efficacy of a combined therapeutic regimen of systemic isotretinoin and prednisolone following the recent concepts of acne pathogenesis and drug kinetics. Methods: A prospective case series was recruited over 15 years. Isotretinoin 0.5 mg/kg bw/d (0.25-0-0.25) and prednisolone 30 mg/d (10-10-10) were administered concomitantly with prednisolone being tapered after that time. The overall efficacy was evaluated at month 1 and every month thereafter. Daily drug doses were split to reduce the risk for adverse effects. Results: 26 patients (20 male, 77%) at a mean age of 19 years and a history of acne vulgaris of 3.2 years presented acutely necrotic and ulcerating skin papules (100%), fever (45%), arthralgia (38.5%), leukocytosis (88.5%) and elevated erythrocyte sedimentation rate (100%). After one month of treatment resolution of systemic signs was achieved in all patients and a >50% skin lesion improvement in 17 patients (65%). Conclusion: The concomitant administration of isotretinoin (0.5 mg/kg bw/d, 0.25-0-0.25) and prednisolone 30 mg/d (10-10-10) is able to resolve systemic signs and markedly improve skin lesions in 65% of the patients at one month.

Acne fulminans and Cutibacterium acnes phylotypes

“…Our case report confirmed a high male predominance in AF (80%), with a significantly lower rate of systemic signs than previously reported . Only one patient experienced fever and arthralgia.…”

“…Our case report confirmed a high male predominance in AF (80%), with a significantly lower rate of systemic signs than previously reported. 2,3,8 Only one patient experienced fever and arthralgia. Some authors have assumed that the condition and 16 In our study, most patients (86.7%) had a family history of acne, including two patients with a family history of AF.…”

“…4 Although acne vulgaris is a ubiquitous disease, AF is rarely reported, with about 200 cases documented in the literature. [1][2][3][7][8][9] The incidence of publications has gradually decreased between its first description and the 2010s, which may reflect a lower occurrence of severe forms with systemic signs or suggest an absence of progression in the knowledge of the pathophysiology of this disease and its treatment.…”

Acne fulminans in a Vietnamese boy successfully treated with prednisolone and ibuprofen: A case report

“…The SAPHO syndrome is an association of distinct skin disorders with pustules with osteoarticular inflammation 10 ; however, the patient in our study had no bony involvement nor impact on internal organs. The treatment of AFs is still a challenge as there have been many reports of different treatments 2,9,11 . Our patient was treated with a combined use of antibiotics for a long period, although his clinical signs did not improve (Figure 1).…”

“…However, antibiotics can be effective if there is microbial colonization 1,6 . Notably, along with general supportive care, systemic corticosteroids are the mainstay of the therapy 5,6,11 . Our patient recovered significantly (Figure 2) after 10 days and 21 days of treatment with oral ibuprofen (500 mg, two times daily) and oral prednisolone (1mg/kg/24 hours), respectively.…”