Background: Acne fulminans is a rare and exuberant variant of acne, mainly affecting young males with a previous history of acne vulgaris. It is a systemic disease of unknown etiology characterized by necrotizing acne associated with constitutional symptoms and laboratory abnormalities.
Case report: Fourteen-year-old male adolescent with no previous history of acne, admitted to Paediatric Department of Hospital S. João - Porto for acne fulminans. Three weeks ago, he had consulted a Dermatologist due to the appearance of painful papular and pustular lesions on the face and anterior chest, along with low-grade fever. He was treated with amoxicillin/clavulanic acid, isotretinoin and prednisolone, with no improvement. Complementary exams showed leukocytosis with neutrophilia and elevated C-reactive protein and transaminases. In the dermatological exam, exuberant and exudative ulcerated and crusted lesions were observed localized on the trunk and, with less intensity, on the face and neck. Systemic prednisolone in higher doses, isotretinoin and topical treatment with polyurethane dressings were instituted, with clinical improvement and gradual involution of skin lesions. The therapy with isotretinoin was maintained for up to 4 months and the therapy with systemic glucocorticoid was maintained for 2 weeks and then progressively tapered.
Comments: The authors describe a clinical case of acne fulminans in a male adolescent, with exuberant dermatological lesions and good therapeutic response to systemic corticoid, isotretinoin and topical treatment. Early diagnosis of acne fulminans and appropriate therapeutic intervention are essential for effective disease control to avoid deforming residual scars and to minimize the risk of recurrence.
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Miranda, J., Correia-Costa, L., Santos-Silva, R. et al. 547 Acne Fulminans, a Rare Variant of Acne: Case Report. Pediatr Res 68, 280 (2010). https://doi.org/10.1203/00006450-201011001-00547