Acne fulminans with osteolytic change in metaphysis of distal radius

Abstract

Acne fulminans is a rare syndrome of fulminant, necrotizing acne associated with bone lesions, constitutional symptoms, and laboratory abnormalities. A case report of an adolescent male with acne fulminans with osteolytic change in metaphysis of the distal radius is presented. Case reportA 14-year-old Korean male was referred to our hospital due to a 2-week history of painful erythematous pustular eruptions with high fever. He had been diagnosed as having acne vulgaris for the past 2 years and sometimes had been administered antibiotics, including minocycline. He was an otherwise healthy boy and had no remarkable family history. Neither intensive physical training nor steroid use prior to onset of disease was noted. On presentation to our clinic, the patient was ill-appearing, trembling, and complained of severe arthralgias (especially wrist pain) and myalgias. Nodulocystic red papules and pustules were scattered over his face, back, and shoulders, and ulcerations with purulent, thick, yellow adherent crust were scattered on his face (Fig. 1).Abnormal laboratory findings included an increase in leukocytes (12.3 9 10 4 /mm 3 ) and neutrophils (84.3%). C-reactive protein level was moderately high at 5.0 mg/ dl. Radiographs showed osteolytic change in metaphysis of the right distal radius (Fig. 2). Liver transaminase levels were normal. Bacterial cultures from blood and skin lesions were negative.Oral administration of a combination of prednisolone 40 mg/day (0.8 mg/kg daily) and minocycline 200 mg/day resulted in rapid improvement of symptoms. The dose of prednisolone was tapered to 10 mg/day within a period of 2 months, and the skin lesions showed gradual Figure 1 Multiple, scaly and some crusted oozing erythematous papules and pustules with hemorrhagic ulcers on the forehead and both cheeks ª

Acne fulminans and its multiple associated factors: a systematic review

“…Overall, 162 patients with AF were described in the selected articles, with a male:female ratio of 14:1 and an average age of 17.35±4.08 years at diagnosis; the minimum and maximum values were 12 years and 40 years, respectively. Ethnic origin was reported for 28/162 patients of whom 15 were Caucasian [4, 8-10, 13-15, 17, 21, 24-26, 28], nine were Asian [11,12,16,18,22,23,27,29], two were African-(American) [19,20], and two were Indian/ Arab [6,7]. The course of previous severe acne vulgaris lesions was reported for 129/162 patients [2, 4, 5, 8-11, 13, 15, 17-20, 21-24, 26-81] with a mean and median time from onset of acne vulgaris to AF of 15.79 months and eight months, respectively; the minimum and maximum values for 75 patients were one month and 12 years, respectively.…”

Isotretinoin‐associated acne fulminans: A multicentre, retrospective study of the European Academy of Dermatology and Venereology Task Force on Acne, Rosacea and Hidradenitis Suppurativa

“…Acne fulminans is rarely reported and, since its description in 1959, 6 there are less than 200 cases of AF documented in the literature, mostly case reports, 7–23 or small case series, 2,4,5,24–28 limiting evidence‐based conclusions. Due to the rarity of the disease, the exact aetiology and pathophysiology of AF remain unknown.…”

“…However, it is worth noting that AF can also occur without any prior drug intake in the majority of cases. [17][18][19]23 We conducted an international collaborative study among members of the European Academy of Dermatology and Venereology (EADV) Task Force on Acne, Rosacea and Hidradenitis Suppurativa (ARHS) to investigate the possible association of oral isotretinoin treatment with the development of AF, aiming to provide new information for the clinical practice. Additional objectives included in the study were the characteristics of patients with AF, the treatments proposed and the prognosis of AF.…”

“…Furthermore, there have been reported cases of AF developing in patients who received certain medications, including testosterone, 14,15 danazol, 20 tetracyclines 16,21 and others. However, it is worth noting that AF can also occur without any prior drug intake in the majority of cases 17–19,23 …”

“…2 In addition, AF has been identified as part of the SAPHO (synovitis-acnepustulosis-hyperostosis-osteitis) syndrome. [2][3][4][5] Acne fulminans is rarely reported and, since its description in 1959, 6 there are less than 200 cases of AF documented in the literature, mostly case reports, [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] or small case series, 2,4,5,[24][25][26][27][28] limiting evidence-based conclusions. Due to the rarity of the disease, the exact aetiology and pathophysiology of AF remain unknown.…”