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Acne fulminans (AF) is a rare, acute, and severe form of acne vulgaris often associated with systemic symptoms. Its treatment is challenging and controversial. We report a case of isotretinoin-induced AF (IIAF) in a 12-year-old boy resistant to traditional therapies (oral steroids and isotretinoin). The patient was successfully treated with adalimumab that can be considered an effective off-label option in the treatment of resistant IIAF in children.

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Generalized pustular psoriasis (GPP), also known as Von Zumbusch psoriasis, represents the most severe form of pustular psoriasis, an immunological mediated inflammatory disease belonging to the group of neutrophilic pustulosis, characterized by the sudden outbreak of small sterile pustules over the majority of the body surface, possibly evolving in erythroderma. GPP is linked to systemic symptoms such as fever, malaise, asthenia, hydroelectrolytic imbalance with dehydration and potentially life-threating conditions such as hypocalcemia, bacteria superinfection and thus, sepsis. 1 Hence this condition must be diagnosed and treated promptly.Herein we describe the case of a 53-year-old woman referred to our department due to the abrupt development of a painful pustular eruption arisen on erythemato-desquamative plaques, involving more than 70% of body surface area (Figure 1A). Patient's medical history was unremarkable, and she did not take any medications. The patient had negative family history of psoriasis. Clinical examination showed the presence of widespread erythematodesquamative plaques roofed by 3-5 mm pustular lesions affecting the major skin folds, also depicted all over the trunk, the upper and lower limbs (Japanese Dermatological Association severity index of GPP = 5) 2 (Figure 1B). The patient recalled suffering from this con-