Acne fulminans

Acne Fulminans (AF), also known as Acute Febrile Ulcerative Acne, is a severe form of acne characterized by a sudden onset of painful, inflamed skin lesions combined with systemic symptoms such as fever, malaise, and arthralgia. It is a rare and the most severe form of acne conglobata, primarily affecting adolescent males. The exact cause of acne fulminans is unknown, but it is believed to involve a combination of genetic, immunological, and environmental factors.

Etiology

The etiology of acne fulminans remains unclear, but several factors are thought to contribute to its development. These include:

• Genetic predisposition: A family history of severe acne can increase the risk.
• Hormonal changes: The condition is most common in adolescent males, suggesting a role for androgens.
• Immunological factors: Abnormal immune responses to Propionibacterium acnes (the bacteria associated with acne) have been observed.
• Systemic inflammation: Elevated levels of systemic inflammatory markers are often present.

Clinical Presentation

Patients with acne fulminans typically present with:

• Sudden worsening of pre-existing acne
• Painful and ulcerative lesions on the skin
• Systemic symptoms such as fever, weight loss, and arthralgia
• In severe cases, bone involvement and hepatosplenomegaly may occur

Diagnosis

Diagnosis of acne fulminans is primarily clinical, based on the characteristic appearance of the skin lesions and the presence of systemic symptoms. Laboratory tests may show elevated inflammatory markers, and imaging studies such as X-rays or MRI may be required to assess bone involvement.

Treatment

Treatment of acne fulminans is challenging and often requires a multidisciplinary approach. Management strategies include:

• Systemic corticosteroids: To reduce inflammation and systemic symptoms.
• Isotretinoin: A potent anti-acne medication, used with caution due to its potential to initially worsen the condition.
• Antibiotics: To address secondary bacterial infections.
• TNF-alpha inhibitors: In cases resistant to traditional treatments, biologic agents targeting TNF-alpha have shown promise.

Prognosis

With appropriate treatment, the prognosis for acne fulminans is generally good, though scarring is common. Early intervention is crucial to minimize the risk of severe scarring and systemic complications.

Prevention

Preventive measures for acne fulminans are limited due to its unclear etiology. However, early treatment of severe acne may reduce the risk of progression to acne fulminans.

See Also

• Acne
• Acne conglobata
• Isotretinoin
• Systemic corticosteroids