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Woźna J, Korecka K, Stępka J, Bałoniak A, Żaba R, Schwartz RA. Acne fulminans treatment: case report and literature review. Front Med (Lausanne) 2024; 11:1450666. [PMID: 39139785 PMCID: PMC11319174 DOI: 10.3389/fmed.2024.1450666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Acne fulminans (AF), a severe acne variant primarily evident in adolescent males, is characterized by the sudden onset of severe and often ulcerating acne with fever and polyarthritis. A case of a 14-year-old initially treated with clindamycin and surgical debridement, highlights the complexity of AF, including challenges in diagnosis, treatment, and the importance of early dermatological consultation. Successful management was achieved through systemic therapy with retinoids and corticosteroids, resulting in significant improvement. This case underscores the necessity of a coordinated effort among dermatologists, endocrinologists, and rheumatologists for effective AF treatment, illustrating the critical role of timely diagnosis and comprehensive care in managing this rare and challenging condition.
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Affiliation(s)
- Julia Woźna
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Korecka
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jan Stępka
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Bałoniak
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert A. Schwartz
- Dermatology, Pathology and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, United States
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Dessinioti C, Dréno B, Bettoli V, Vural S, Brzezinski P, Nassif A, Svensson Å, Zouboulis CC. Isotretinoin-associated acne fulminans: A multicentre, retrospective study of the European Academy of Dermatology and Venereology Task Force on Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2024; 38:197-204. [PMID: 37643921 DOI: 10.1111/jdv.19477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Acne fulminans (AF) is a rare severe acne entity. Although occasionally reported, it is unclear whether AF development is associated with oral isotretinoin treatment. OBJECTIVES To investigate the occurrence of isotretinoin-associated AF, clinical characteristics and prognosis at follow-up. METHODS An international, multicentre, retrospective study was performed in eight hospitals following the call of the EADV Task Force on Acne, Rosacea and Hidradenitis Suppurativa (ARHS). Characteristics of patients treated with isotretinoin before the development of AF (isotretinoin-associated acne fulminans, IAF) were compared with non-IAF (NAF). RESULTS Forty-nine patients diagnosed with AF from 2008 to 2022 were included (mean age 16.4 years, SD 2.9, 77.6% male). Αrthralgias/arthritis occurred in 11 patients (22.9%). AF occurred without any previous acne treatment in 26.5% of the patients. Overall, 28 patients (57.1%) developed AF after oral isotretinoin intake (IAF group), while the remaining 21 patients (42.9%) developed AF without previous oral isotretinoin administration (NAF group). IAF occurred after a median duration of isotretinoin treatment of 45 days (IQR: 30, 90). Patients with IAF were more frequently male compared to patients with NAF (89.3% vs. 61.9%, respectively, p = 0.023). There were no differences in patients with IAF versus NAF in patient age, the duration of pre-existing acne, a family history of AF, the distribution of AF lesions or the presence of systemic symptoms or arthralgias. Regarding the management of AF, patients with IAF were treated more frequently with prednisolone (96.2%) compared to those with NAF (70%; p = 0.033) and less frequently with isotretinoin (32.1%) compared to NAF (85.7%; p < 0.001). At a median follow-up of 2.2 years, 76.4% of patients were free of AF and scarring was present in all patients. CONCLUSIONS No specific clinical or demographic characteristics of IAF compared with NAF could be detected, a fact that does not support IAF as a district clinical entity.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Brigitte Dréno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes, France
| | - Vincenzo Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - Secil Vural
- Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Turkey
| | - Piotr Brzezinski
- Department of Physiotherapy and Medical Emergency, Faculty of Health Sciences, Pomeranian University, Slupsk, Poland
- Department of Dermatology, Provincial Specialist Hospital, Slupsk, Poland
| | | | - Åke Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Gutiérrez-Meré R, Tajes I, Diéguez P, Soto-García D, Martínez-Fernández S, Batalla A. Acne Fulminans: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:763-771. [PMID: 37245603 DOI: 10.1016/j.ad.2023.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/30/2023] Open
Abstract
Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We conducted a narrative review of the literature on acne fulminans based on a search for relevant English- and Spanish-language articles published in Medline. We included case reports and case series. The main aim was to describe the clinical and demographic characteristics of patients with acne fulminans. A secondary aim was to determine whether quality of life was affected by the site or extent of lesions. We reviewed 91 articles describing 212 cases of acne fulminans. The mean age of the patients (91.94% male) was 16.6 years. A personal and family history of acne vulgaris was reported for 97.63% and 54.90% of patients, respectively. A trigger was identified in 44.79% of cases. The main cause was pharmacologic (96.63%) and the main drug isotretinoin (65.28%). The sites most often affected were the face (89.31%), the posterior trunk (77.86%), and the anterior trunk (74.81%). The predominant disease subtype was acne fulminans with systemic symptoms (59.12%), which were mostly general (97.06%). Systemic corticosteroids were the most widely used treatment (81.03%). The impact of the disease on quality of life was reported for 2 patients. In conclusion, acne fulminans mainly affects the face and trunk of male adolescents with a history of acne vulgaris. The main subtype was acne fulminans with systemic symptoms, and most patients were treated with systemic corticosteroids. The effect of acne fulminans on quality of life is underreported.
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Affiliation(s)
- R Gutiérrez-Meré
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España.
| | - I Tajes
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, España
| | - P Diéguez
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, España
| | - D Soto-García
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
| | - S Martínez-Fernández
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, España; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España
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Gutiérrez-Meré R, Tajes I, Diéguez P, Soto-García D, Martínez-Fernández S, Batalla A. [Translated article] Acne Fulminans: A Narrative Review. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T763-T771. [PMID: 37506824 DOI: 10.1016/j.ad.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/06/2023] [Indexed: 07/30/2023] Open
Abstract
Acne fulminans is a severe and rare form of inflammatory acne. Lesion severity and subsequent scarring has a negative impact on the patient's quality of life. We conducted a narrative review of the literature on acne fulminans based on a search for relevant English- and Spanish-language articles published in Medline. We included case reports and case series. The main aim was to describe the clinical and demographic characteristics of patients with acne fulminans. A secondary aim was to determine whether quality of life was affected by the site or extent of lesions. We reviewed 91 articles describing 212 cases of acne fulminans. The mean age of the patients (91.94% male) was 16.6 years. A personal and family history of acne vulgaris was reported for 97.63% and 54.90% of patients, respectively. A trigger was identified in 44.79% of cases. The main cause was pharmacologic (96.63%) and the main drug isotretinoin (65.28%). The sites most often affected were the face (89.31%), the posterior trunk (77.86%), and the anterior trunk (74.81%). The predominant disease subtype was acne fulminans with systemic symptoms (59.12%), which were mostly general (97.06%). Systemic corticosteroids were the most widely used treatment (81.03%). The impact of the disease on quality of life was reported for two patients. In conclusion, acne fulminans mainly affects the face and trunk of male adolescents with a history of acne vulgaris. The main subtype was acne fulminans with systemic symptoms, and most patients were treated with systemic corticosteroids. The effect of acne fulminans on quality of life is under-reported.
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Affiliation(s)
- R Gutiérrez-Meré
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain.
| | - I Tajes
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, Spain
| | - P Diéguez
- Escuela Universitaria de Enfermería, Diputación Provincial de Pontevedra, Universidad de Vigo, Vigo, Pontevedra, Spain
| | - D Soto-García
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
| | - S Martínez-Fernández
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
| | - A Batalla
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Área Sanitaria de Pontevedra y O Salnés, Pontevedra, Spain; Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, Spain
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