Severe Acne- Acne Fulminans

Acne Fulminans (AF)

This subtype of severe acne is again more common in males. It has an abrupt onset and is usually seen in the 2nd decade of life. It also leads to extreme disfiguring scarring. The acne does have a tendency to ulcerate.

A unique thing about this type of acne is that it is associated with the fever and joint pain (usually knee and the hip). Some believe that it may be related to an infectious organism. Despite the belief that it is infectious, it does not respond to antibiotics. The usual drugs of treatment include Isotretinoin (Accutane) and oral steroids.

Although the disease suddenly comes on, it is believed that in some cases the disorder may be related to intake of the male hormone, Testosterone.

AF usually has the following features:

o It usually presents suddenly

o The acne is often ulcerated

o Fever is a common presentation

o Joint pain in the knees or hips is common

o No response to antibiotics

o More common in males than females

o More common in individuals with a past history of acne

o May develop a skin rash with nodules

o The spleen may be enlarged

o Usually have a painful limp

o Joint fluid does not reveal the presence of any infection

o Loss of appetite

o Weight loss

o Blood work is abnormal

The recommended treatment for AF is a combination of oral steroids and Isotretinoin.

The steroids are generally started at a low dose and continued for about 6 weeks. The steroid dose is quickly tapered to avoid the side effects.

Other recommends that intralesional steroids may also help

So far antibiotics have failed to show any response

Recently an antibody towards Tumor Necrosis Factor has been developed and is now available for the resistant type of AF

Many individuals with Acne Fulminans require admission to hospital for treatment.