Acne fulminans

Last Updated: 2020-05-21

Author(s): Anzengruber, Navarini

Pautrier 1937.

Plewig and Kligman 1975.

Acute febrile ulcerative conglobate acne, acne maligna.

Acute illness with severe general symptoms (high fever, joint pain) and acne conglobata.

Only in young men and an occurring disease between the ages of 13-16.

Multifactorial cause from androgenic hormone action and inflammatory factors, which suddenly reaches "Tipping Point" for unknown reason.

Within a few weeks the following symptoms occur abruptly:

  • The acne conglobata, which produces Pyoderma gangrenosum like skin ulcerations
  • Joint pain (sacroiliac-, hip-, knee and elbow pain)
  • Fever and reduced general state of health
  • Proteinuria and leucocytosis
  • Splenomegaly
  • Aseptic bone necrosis (SAPHO syndrome)
  • Leucocytoclastic vasculitis
  • Erythema nodosum
  • Haemorrhagic necrosis
  • Pyogenic granuloma-like skin changes
  • Medical history
  • Clinical picture
  • BB, BSG, liver & kidney values
  • U-status
  • Radiological clarification if necessary
  • Rheumatological consultation

Acne vulgaris.

Recurrence usually does not occur.

  • Physical rest
  • Prednisolone p.o 1 mg per kg body weight tapered within 6-8 weeks
  • Oral antibiosis
    • Clindamycin, weight-adjusted.
    • Cephalosporins, weight-adjusted.
  • Isotretinoin (low-dose)
  1. Peleg H, Koslowski B, Hiller N, Heyman SN. Radiologic features of acne fulminans. Isr Med Assoc J. 2014 Jun;16(6):393-4.
  2. Giavedoni P, Mascaró-Galy JM, Aguilera P, Estrach-Panella T. Acne fulminans successfully treated with cyclosporine and isotretinoin. J Am Acad Dermatol. 2014 Feb;70(2):e38-9.