Acne fulminans in Adult
The inciting antigen is believed to be from Propionibacterium acnes. Testosterone may play a role in the pathogenesis as well, as this steroid hormone increases sebum excretion and the population density of P. acnes. Circulating immune complexes have been found in patients with acne fulminans.
In acne fulminans without systemic symptoms (AF-WOSS), patients present with a sudden onset of large inflammatory cysts, nodules, papules, pustules, and abscesses. In acne fulminans with systemic symptoms (AF-SS), patients are febrile with systemic complaints, which may include polyarthralgia, myalgias, malaise, anorexia, and weight loss. Splenic tenderness, erythema nodosum, and bone pain from aseptic osteolysis have been reported.
Isotretinoin treatment, especially if given at high doses, may induce acne fulminans in individuals with severe acne. The diagnosis is known as isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS), since systemic symptoms are typically absent. In rare cases, systemic symptoms accompany, and the diagnosis is known as isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS).
Acne fulminans can be the dermatologic manifestation of SAPHO (synovitis, pustulosis, hyperostosis, and osteitis), PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne), PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis), and PAPASH (pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hidradenitis) syndromes.
L70.8 – Other acne
4659007 – Acne fulminans
- Acne conglobata lacks many of the systemic manifestations of acne fulminans, and onset is typically at a later age. Acne conglobata exhibits polyporous comedones and noninflammatory cysts.
- Steatocystoma multiplex may become infected, but usually does not display the systemic findings.
- Acne vulgaris
- Staphylococcal or gram-negative folliculitis
- Pyoderma faciale
- Hidradenitis suppurativa
Last Updated: 07/07/2017