What Is Acne Fulminans ?.

Acne fulminans is a rare and very severe form of acne conglobata associated with systemic symptoms. It nearly always affects males.

It is characterised by:
* Abrupt onset
* Inflammatory and ulcerated nodular acne on chest and back
* Severe acne scarring
* Fluctuating fever
* Painful joints
* Malaise (ie. the patient feels unwell)
* Loss of appetite and weight loss
* Raised white blood cell count.

Although it mostly just happens, it may be precipitated by:

* Testosterone (legally prescribed or illegally taken to enhance muscle growth)
* Isotretinoin

The syndrome SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) may be a serious complication of acne fulminans.

Management.

Patients with acne fulminans should consult a dermatologist urgently. Management can prove difficult, and several medications are usually required. These may include:

* High doses of oral antibiotics such as erythromycin (2g/day)
* Anti-inflammatory medications such as salicylates (aspirin)
* Systemic oral steroids such as prednisone (20-60mg/day)
* Dapsone
* Isotretinoin

Topical acne medications are unhelpful.

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