Acne Fulminans Treated with Isotretinoin and “Pulse” Corticosteroids

Allison, Matthew; Dunn, Cary L.; Person, Donald A.

doi:10.1111/j.1525-1470.1997.tb00425.x

Cited by 18 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,6 A systemic steroid has often been recommended as the treatment of choice 3 and the combination of isotretinoin and a steroid has been used. 3,7,8 Over the past 25 years, we have been involved directly or more often indirectly (i.e. by telephone or letter because of distances involved) in the management of 25 patients with acne fulminans.…”

mentioning

confidence: 99%

The treatment of acne fulminans: a review of 25 cases

Seukeran

Cunliffe

1999

British Journal of Dermatology

View full text Add to dashboard Cite

The treatment of acne fulminans has been difficult. It is difficult to perform a controlled treatment trial due to the rarity of the complication. However, it is possible to compare four different therapeutic regimens which have evolved with time in the management of 25 patients over a period of 25 years. Oral antibiotics produced a slow response in the resolution of acne and systemic symptoms. The addition of a systemic steroid produced a quick resolution of systemic features, but the time until resolution of the acne was longer than when it was used in combination with oral isotretinoin. The protocols which used a combination of prednisolone and isotretinoin led to faster control of systemic features as well as clearance of acne when compared with other protocols. This was particularly so if the oral steroid was used sooner rather than later. We conclude that the preferred treatment of acne fulminans is oral prednisolone 0.5-1 mg/kg daily for 4-6 weeks (thereafter slowly reduced to zero) with oral isotretinoin being added to the regimen at the fourth week, initially at 0.5 mg/kg daily and gradually increased to achieve complete clearance.

show abstract

mentioning

confidence: 99%

The treatment of acne fulminans: a review of 25 cases

Seukeran

Cunliffe

1999

British Journal of Dermatology

View full text Add to dashboard Cite

show abstract

“…10 Systemic isotretinoin has been used successfully in acne fulminans but, paradoxically, may precipitate acne fulminans; accordingly, it is not the initial treatment of choice. 11 So we suggest the simultaneous use of antibiotics and systemic steroids at first. After the acute inflammatory phase of the disease, minocycline was stopped and isotretinoin was started and maintained for preventing recurrence.…”

Section: Discussionmentioning

confidence: 98%

“…On the other hand, oral steroids should be started initially to deal with systemic symptoms and gradually reduced to avoid adverse effects of a prolonged course of systemic steroids . Systemic isotretinoin has been used successfully in acne fulminans but, paradoxically, may precipitate acne fulminans; accordingly, it is not the initial treatment of choice . So we suggest the simultaneous use of antibiotics and systemic steroids at first.…”

Section: Discussionmentioning

confidence: 99%

Acne fulminans with osteolytic change in metaphysis of distal radius

et al. 2015

View full text Add to dashboard Cite

Acne fulminans is a rare syndrome of fulminant, necrotizing acne associated with bone lesions, constitutional symptoms, and laboratory abnormalities. A case report of an adolescent male with acne fulminans with osteolytic change in metaphysis of the distal radius is presented. Case reportA 14-year-old Korean male was referred to our hospital due to a 2-week history of painful erythematous pustular eruptions with high fever. He had been diagnosed as having acne vulgaris for the past 2 years and sometimes had been administered antibiotics, including minocycline. He was an otherwise healthy boy and had no remarkable family history. Neither intensive physical training nor steroid use prior to onset of disease was noted. On presentation to our clinic, the patient was ill-appearing, trembling, and complained of severe arthralgias (especially wrist pain) and myalgias. Nodulocystic red papules and pustules were scattered over his face, back, and shoulders, and ulcerations with purulent, thick, yellow adherent crust were scattered on his face (Fig. 1).Abnormal laboratory findings included an increase in leukocytes (12.3 9 10 4 /mm 3 ) and neutrophils (84.3%). C-reactive protein level was moderately high at 5.0 mg/ dl. Radiographs showed osteolytic change in metaphysis of the right distal radius (Fig. 2). Liver transaminase levels were normal. Bacterial cultures from blood and skin lesions were negative.Oral administration of a combination of prednisolone 40 mg/day (0.8 mg/kg daily) and minocycline 200 mg/day resulted in rapid improvement of symptoms. The dose of prednisolone was tapered to 10 mg/day within a period of 2 months, and the skin lesions showed gradual Figure 1 Multiple, scaly and some crusted oozing erythematous papules and pustules with hemorrhagic ulcers on the forehead and both cheeks ª

show abstract

“…The relapse usually occurs 2–8 weeks after the acute attack when the corticosteroids dosage is reduced or stopped; the relapse manifests as worsening of arthralgia and sometimes fever, but usually not as worsening of the cutaneous nodules 2 . Pulsed steroid treatment to control the acute inflammatory phase of the disease may be utilized, with isotretinoin started after the acute inflammatory phase of the disease has been controlled 45 . Systemic corticosteroids (e.g.…”

Section: Treatmentmentioning

confidence: 99%

“…2 Pulsed steroid treatment to control the acute inflammatory phase of the disease may be utilized, with isotretinoin started after the acute inflammatory phase of the disease has been controlled. 45 Systemic corticosteroids (e.g. 0.5-1.0 mg ⁄ kg of prednisolone) are indicated in AF, because they effectively control the skin lesions, reduce fever and also have a favourable effect on the musculoskeletal symptoms.…”

Section: Treatmentmentioning

confidence: 99%

Acne fulminans: explosive systemic form of acne

Żaba

Schwartz²,

Jarmuda

et al. 2010

Acad Dermatol Venereol

View full text Add to dashboard Cite

Acne fulminans (AF) is a rare severe form of acne vulgaris associated with systemic symptoms. It primarily affects male adolescents. Although the aetiology of AF remains unknown, many theories have been advanced to explain it. There have been reported associations with increased androgens, autoimmune complex disease and genetic pre-disposition. The disease is destructive, with the acute onset of painful, ulcerative nodules on the face, chest and back. The associated systemic manifestations such as fever, weight loss and musculoskeletal pain are usually present at the onset. The patients are febrile, with leucocytosis and an increased erythrocyte sedimentation rate. They may require several weeks of hospitalization. The treatment of AF has been challenging; the response to traditional acne therapies is poor. The recommended treatment is aggressive and consists of a combination of oral steroids and isotretinoin. To avoid the relapses, duration of such treatment should not be less than 3-5 months. Although the prognosis for patients treated appropriately is good, these acute inflammatory nodules often heal with residual scarring.

show abstract

Acne Fulminans Treated with Isotretinoin and “Pulse” Corticosteroids

Cited by 18 publications

References 23 publications

The treatment of acne fulminans: a review of 25 cases

The treatment of acne fulminans: a review of 25 cases

Acne fulminans with osteolytic change in metaphysis of distal radius

Acne fulminans: explosive systemic form of acne

Contact Info

Product

Resources

About