Almost everyone will experience acne at some point in their lifetime, and for the majority of people the symptoms are merely aggravating and embarrassing; however, there are some very severe forms of acne that cause major health problems.
Acne fulminans, also called acne maligna, is one of the worst types of acne, causing painful and disfiguring skin lesions, fever, joint pain, and even bone infections and deformation. Acne fulminans treatment with steroids and isotretinoin (Accutane) should be initiated as soon as symptoms present themselves to avoid hospitalization.
The initial symptoms of acne fulminans are:
- Sudden-onset pain and inflammation of the joints
- Lymph node swelling in the neck. This is the progression of the joint pain and inflammation, which causes the neck to become stiff and inflexible.
- The lymph node swelling will eventually go away, but as it does, the joint pain and swelling will increase.
- The victim loses their appetite, resulting in weight loss and muscle atrophy.
Acne fulminans typically activates at around the age of thirteen, at the peak of puberty, and the victims are almost always male.
About Acne Fulminans
Acne fulminans is very rare; only about 100 cases have been documented, and it appears to be occurring less frequently . It comes on very suddenly. Usually, acne fulminans is the result of unsuccessful treatment for acne conglobata, which is a form of severe cystic acne. Although the exact cause of acne fulminans is not known, it appears to be an immunological response triggered by elevated levels of testosterone, which in turn causes an increase in sebum production and p. acnes bacteria.
Appearance of Acne Fulminans
The skin lesions caused by acne fulminans resemble those of acne conglobata, but they also become ulcerated, deep craters that eventually develop crusty, irregular scabs. They tend to spread and overlap and break open with movement, seeping matter that causes the person’s clothing to stick to the lesion, worsening the inflammation. The lesions typically appear on the torso, though rare cases of facial acne fulminans have been documented. If allowed to worsen, acne fulminans causes bone lesions and deformities, especially in the sternum, knees, and elbows.
Acne Fulminans Treatment Options
- Acne fulminans treatment should begin right away, or the person risks a lengthy hospital stay. If the condition is caught soon enough, the recommended course of treatment is a combination of isotretinoin (Accutane) and oral steroids. If the infection is not diagnosed in time, the victim will have to remain in hospital for weeks, dealing with the long-lasting side effects of this devastating condition.
- The steroids (usually prednisone or another corticosteroid) should be given over a period of six weeks, and gradually tapered off. Steroids have been known to cause or aggravate acne vulgaris, so an increase in skin eruptions should be anticipated.
- A course of isotretinoin (Accutane) should be initiated at four weeks in a dosage of 0.25 mg. per kilogram of body weight daily and increased to 120 mg. per kilogram.
- Isotretinoin can cause a temporary increase in lesions, but they will gradually dry up and heal, owing to the isotretinoin (Accutane) decreasing sebum production and improving the skin’s ability to heal and generate new tissue.
Acne fulminans is a serious medical condition and needs to be treated immediately to avoid severe medical problems. Acne fulminans treatment using isotretinoin (Accutane) and steroids will normally bring the lesions and other symptoms under control.