The treatment of acne fulminans: a review of 25 cases

Abstract

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.

A Case With Bilateral Sacroiliitis and Polyneuropathy Development Due to Isotretinoin Use

“…It exerts its effects via retinoic acid receptors. 1 Isotretinoin-related musculoskeletal adverse effects include arthralgia, myalgia, and vasculitis. Adverse effects may be observed in 15% of the patients.…”

Acne fulminans e isotretinoína: relato de caso

“…The medications currently used are only effective with prolonged use, triggering several side effects.³ Oral antibiotics produce discreet response in the cutaneous condition and in the systemic symptoms. 13 The available therapies are glucocorticoids, isotretinoin and levamisole. 1,3 Systemic glucocorticoids quickly improve skin lesions and systemic symptoms, although they tend to relapse when the dosage is decreased.…”

Moderne Aknetherapie

“…Systemische Kortikosteroide können bei sehr schweren entzündlichen Akneverlaufsformen wie Acne fulminans notwendig werden, um die überschieûende immunologische Reaktion und initiale Progression unter Isotretinoin zu unterdrücken [44,60,61]. Die Kombination aus täglich 0,5 ± 1,0 mg/kg Körper-gewicht Isotretinoin und Prednisolon (30 mg/d) über einen Monat kann die Umwandlung der fulminanten Akne-Verlaufsform in eine gewöhnliche entzündliche Verlaufsform beschleunigen.…”