The New England Journal of MedicineAcne Fulminans

Read the original article

A 19-year-old male with a history of mild acne vulgaris presented with a 10-day history of rapidly worsening acne, fever, muscle aches, and knee pain. Physical examination revealed diffuse papulonodular and pustular lesions with crusting across various body parts. Laboratory tests indicated neutrophilic leukocytosis and elevated inflammatory markers. A skin culture grew Cutibacterium acnes, and a biopsy showed suppurative folliculitis. Diagnosed with acne fulminans, the patient was treated with oral glucocorticoids, isotretinoin, and a topical antimicrobial agent. At a 6-week follow-up, his systemic symptoms had resolved, and the acne had significantly improved.

Key Points:

• Patient Presentation: A 19-year-old male with a history of mild acne vulgaris presented with rapidly worsening acne, fever, muscle aches, and knee pain.
• Physical Examination: Noted diffuse papulonodular and pustular lesions with crusting on the face, neck, shoulders, chest, back, and thighs.
• Laboratory Findings: Neutrophilic leukocytosis, elevated erythrocyte sedimentation rate, and C-reactive protein level.
• Microbiological and Histopathological Findings: Skin culture grew Cutibacterium acnes; biopsy showed suppurative folliculitis with dermal edema.
• Diagnosis: Acne fulminans, an acute, severe variant of inflammatory acne, often associated with systemic symptoms.
• Treatment: Initiated oral glucocorticoids, isotretinoin, and a topical antimicrobial agent.
• Outcome: At 6-week follow-up, systemic symptoms resolved, and acne abated.

Acne fulminans has been associated with increased androgens (male hormones), autoimmune complex disease and genetic predisposition. It may be related to an explosive hypersensitivity reaction to surface bacteria (Cutibacteria acnes). (DermNet)

More in Dermatology