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Acne fulminans in Child
Other Resources UpToDate PubMed

Acne fulminans in Child

Contributors: Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Acne fulminans is a rare, highly inflammatory, immunologically induced form of acne that occurs mainly in male patients between 13 and 22 years old. Individuals of Northern European descent are predominantly affected. Individuals of East Asian descent may experience a milder form of acne fulminans. Risk factors include chronic severe acne (several months or years), a positive family history, high testosterone levels, and history of anabolic steroid use.

The inciting antigen is believed to be from Cutibacterium acnes (formerly known as Propionibacterium acnes). Testosterone may play a role in the pathogenesis as well, as this steroid hormone increases sebum excretion and the population density of C 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.

Codes

ICD10CM:
L70.8 – Other acne

SNOMEDCT:
4659007 – Acne fulminans

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:07/07/2017
Last Updated:09/17/2019
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Acne fulminans in Child
Acne fulminans : Fever, Painful skin lesions, Primarily truncal distribution, Pustule, Arthralgia, Myalgia
Clinical image of Acne fulminans
Numerous brightly erythematous papules and nodules, many crusted, on the upper back.
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