Acne fulminans: Description, Causes and Risk FactorsAcne fulminans is a rare and unique variant of acne and is characterized by a sudden, violent onset of tender, nodulocystic and ulcerocrusted lesions over the back and chest, with fever, arthralgia and weight loss, affecting predominantly adolescent males and females. The exact etiopathology is unknown although a hypersensitivity reaction is the most accepted hypothesis.It is an uncommon, immunologically induced, systemic disease in which the triggering antigen is believed to be from Propionibacterium acnes. Some authors note that elevated blood levels of testosterone may play an important role in the pathogenesis of acne fulminans. High levels of testosterone and anabolic steroids cause an increase in sebum excretion and in the population density of P. acnes. The increase in the amount of P. acnes or related antigens may trigger the immunologic reaction in some individuals and lead to an occurrence of acne fulminans. In addition to testosterone, isotretinoin may also precipitate acne fulminans, possibly related to highly increased levels of P. acnes antigens in the patient's immune system.Another theory postulates that it may be an autoimmune complex disease because circulating immune complexes have been demonstrated in some patients with acne fulminans. Immunologically, the reaction is a type III or IV hypersensitivity reaction.Genetic factors may play an important role in some patients; 3 sets of identical twins who developed an identical pattern of acne fulminans have been documented. Acne may be the only clinical sign of androgen excess in men, and one report is available about a boy with acne fulminans and androgen excess due to late-onset congenital adrenal hyperplasia.It is very rare; only about 100 cases have been documented so far, 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.Acne fulminans is a serious medical condition and needs to be treated immediately by Cosmetologist.Symptoms:Acne fulminans typically activates at around the age of thirteen, at the peak of puberty.Symptoms may include: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.
Diagnosis:Diagnosis is usually clinical. The occurrence of bone lesions in this condition is rare but well recognized, and often bone biopsies are performed to rule out malignancy or infection.Treatment:Systemic steroids alone or in combination with isotretinoin are the cornerstones of its treatment. The successful management of the disease in an Indo-American boy with a combination of minocycline and dapsone daily is reported. The efficacy of minocycline as an alternative to steroids in the management of acne fulminans is highlighted.Musculoskeletal symptoms are common in patients with the disease. Systemic steroid treatment rapidly controls the skin lesions and systemic symptoms. The duration of steroid treatment should be 2 to 4 months to avoid relapses. Therapy with isotretinoin, antibiotics, or both was often combined with steroids, but the role of these agents is still uncertain.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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