Adalimumab in the Management of Isotretinoin-Induced Acne Fulminans: Report of a Case

Marasca, Claudio; Fabbrocini, Gabriella; Abategiovanni, Luisa; Camela, Elisa; Nocerino, Mariateresa; Guida, Adriana Di; Salvatores, Gaia De Fata

doi:10.1159/000512032

Cited by 9 publications

(34 citation statements)

References 12 publications

(16 reference statements)

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“…An additional 42 articles were excluded following full-text review, resulting in 57 articles (Figure). Of these, 53 articles reported individual clinical data from 64 patients. The remaining 4 articles only provided grouped data rather than individual patient data, so these studies were omitted when calculating the following summary statistics.…”

Section: Resultsmentioning

confidence: 99%

Role of Tumor Necrosis Factor–α Inhibitors in the Treatment and Occurrence of Acne

et al. 2023

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ImportanceTumor necrosis factor–α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner.ObjectiveTo characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis.Evidence ReviewA systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined.FindingsA total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms.Conclusions and RelevanceThe results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.

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Section: Resultsmentioning

confidence: 99%

Role of Tumor Necrosis Factor–α Inhibitors in the Treatment and Occurrence of Acne

et al. 2023

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“…8,12,[14][15][16][17]19 Antibiotics had been taken just prior to AF in 10/12 cases (83%). [8][9][10][11][12][13][15][16][17]19 Investigations Abrupt acne flares were described in 10/12 of cases (83%), [7][8][9][10][11][12][13][14]16,17 with hemorrhagic nodules/plaques in 10/12 (83%), [7][8][9][11][12][13][15][16][17] ulcers in 9/12 (75%), [7][8][9][10][11][12][13]16,17 crusts in 6/12 (50%), 7,8,11,12,17,19 and erosions in 3/12 (25%).…”

Section: Demographicsmentioning

confidence: 99%

“…[8][9][10][11][12][13][15][16][17]19 Investigations Abrupt acne flares were described in 10/12 of cases (83%), [7][8][9][10][11][12][13][14]16,17 with hemorrhagic nodules/plaques in 10/12 (83%), [7][8][9][11][12][13][15][16][17] ulcers in 9/12 (75%), [7][8][9][10][11][12][13]16,17 crusts in 6/12 (50%), 7,8,11,12,17,19 and erosions in 3/12 (25%). 11,12,19 Concomitant symptoms were 9/12 (75%) arthralgias, 7,8,10,13,…”

Section: Demographicsmentioning

confidence: 99%

Tumor necrosis factor‐α inhibitor treatment of acne fulminans – a clinical and literature review

Taudorf,

Jensen,

Bouazzi

et al. 2023

J Deutsche Derma Gesell

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SummaryAcne fulminans (AF) is a rare, serious, sudden‐onset and long‐lasting skin disease that causes scarring of face and body. Standard treatment with combined long‐term isotretinoin and prednisolone is not always sufficient and has a well‐known propensity for adverse effects leaving an unmet need for improved therapy. Case reports suggest that tumor necrosis factor (TNF)‐α inhibitors may play a role in the management of AF. In a 3‐year retrospective data collection from two dermatology centers and literature review of clinical cases of acne fulminans treated with anti‐TNF‐α therapy, three clinical cases and twelve literature cases were identified. A total of five different TNF‐α inhibitors have been tested, with adalimumab being the most commonly used. Clinical response was seen after 1 month in 2/3 (67%) clinical cases and 5/12 (42%) literature cases, respectively, and treatment was successful in 2/3 (67%) and 11/12 (92%) after a median 3–7 months. All reported adverse effects were mild and reversible. Anti‐TNF‐α treatment may provide rapid improvement in patients with AF when initial treatment with isotretinoin and prednisolone fails. However, randomized controlled trials are lacking, and exact dosage and timing need to be explored before clinical implementation.

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“…Experience with TNF-α inhibitors in the treatment of IIAF is very limited. 6,7 We are aware of only two reported cases of IIAF treated with adalimumab. A 12-year-old patient with corticosteroid-dependent IIAF and SSs was prescribed adalimumab (40 mg every other week), leading to the resolution of inflammatory skin lesions and SSs within 3 weeks.…”

mentioning

confidence: 99%

“…A 12-year-old patient with corticosteroid-dependent IIAF and SSs was prescribed adalimumab (40 mg every other week), leading to the resolution of inflammatory skin lesions and SSs within 3 weeks. 6 A 16-year-old patient with IIAF associated with bilateral sacroiliitis refractory to steroids, was treated successfully with adalimumab 40 mg every 2 weeks, allowing rapid resolution of cutaneous and articular manifestations within 1 month. 7 AF can frequently be associated with other inflammatory conditions, such as inflammatory rheumatism and HS, in which TNF-α is considered the major pro-inflammatory cytokine involved in the pathogenesis.…”

mentioning

confidence: 99%

Efficacy of tumor necrosis factor‐alpha inhibitors in the treatment of isotretinoin‐induced acne fulminans

Nasseh,

Brun,

Theret

et al. 2023

Acad Dermatol Venereol

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Adalimumab in the Management of Isotretinoin-Induced Acne Fulminans: Report of a Case

Cited by 9 publications

References 12 publications

Role of Tumor Necrosis Factor–α Inhibitors in the Treatment and Occurrence of Acne

Role of Tumor Necrosis Factor–α Inhibitors in the Treatment and Occurrence of Acne

Tumor necrosis factor‐α inhibitor treatment of acne fulminans – a clinical and literature review

Efficacy of tumor necrosis factor‐alpha inhibitors in the treatment of isotretinoin‐induced acne fulminans

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