Pseudo-acne fulminans associated with oral isotretinoin

Abstract

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation.

Isotretinoin‐induced acne fulminans without systemic symptoms with concurrent exuberant granulation tissue

“…The pathophysiology driving either process is unclear. Some authors have hypothesized that an overwhelming immunologic reaction against Propionibacterium acnes antigen, which is released in large quantities after initiation of isotretinoin therapy, drives the former . The latter process, some hypothesize, is driven though the stimulatory effects of retinoids on wound healing and collagen synthesis .…”

“…Treatment of acne with isotretinoin can cause severe worsening of acne, resulting in painful ulcerating lesions without associated systemic symptoms. This reaction has been named isotretinoin‐induced acne fulminans without systemic symptoms (IIAF‐WOSS) . Another known adverse effect of isotretinoin therapy, an exuberant granulation tissue response, can occur concurrently, inhibiting wound repair .…”

“…This reaction has been named isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). [1][2][3] Another known adverse effect of isotretinoin therapy, an exuberant granulation tissue response, can occur concurrently, inhibiting wound repair. 4 We report a case of IIAF-WOSS with exuberant granulation tissue response that was treated successfully with topical clobetasol ointment.…”

Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone as Promising Regimes

“…Systemic constitutional symptoms of AF include fluctuating fever, painful joints, malaise, loss of appetite, and laboratory abnormalities [4, 5]. The face is usually less severely involved than the trunk [5].…”

Acne fulminans in the course of oral isotretinoin treatment. Presentation of cases

“…However, in some cases of rapid exacerbation of acne, induced by isotretinoin administration, systemic symptoms may not occur. Such symptoms are recognized as "pseudo-acne fulminans" or "acne fulminans sine fulminans" [9,10].…”