A case of acne fulminans during isotretinoin treatment

Year 2024, Volume: 3 Issue: 3, 128 - 131, 31.12.2024

Hanife Merve Sivas

https://doi.org/10.58651/jomtu.1517875

Abstract

Acne fulminans (AF) is a rare ulcerative variant of acne. Systemic symptoms are added to the sudden onset of severe acne. A 17-year-old male patient presented with watery crusted lesions on the face and chest, fever and myalgia. He was receiving systemic isotretinoin for nodulocystic acne. Two weeks after treatment, the lesions had become painful, ulcerated and hemorrhagic. Dermatological examination revealed severe ulcerated lesions on the chest and back covered with a hemorrhagic crust. White blood cell count was 17,500, erythrocyte sedimentation rate (ESR) was 50 mm/h, C-reactive protein (CRP) was 5.5 mg/L. Systemic isotretinoin treatment was discontinued with a diagnosis of acne fulminans. Oral prednisolone 1 mg/kg and clindamycin 300 mg/day were started. Lesions regressed and corticosteroid treatment was tapered and discontinued.

Keywords

NODULOCYSTIC ACNE, acne fulminans, isotretinoin

İzotretinoin tedavisi sırasında gelişen akne fulminans olgusu

Abstract

Akne fulminans (AF), aknenin nadir rastlanan ülseratif bir varyantıdır. Ani başlayan şiddetli akneye sistemik semptomlar eklenir. 17 yaşında erkek hasta yüz ve göğüste sulantılı kabuklu yaralar, ateş ve kas ağrılarıyla başvurdu. Nodülokistik akne nedeniyle sistemik izotretinoin kullanımı mevcuttu. Tedaviden iki hafta sonra lezyonları ağrılı, ülseratif, hemorajik karakter kazanmıştı. Dermatolojik muayenede göğüs ve sırt bölgesinde şiddetli yer yer hemorajik krutla kaplı ülsere lezyonlar mevcuttu. Beyaz küre 17.500, eritrosit sedimentasyon hızı (ESH) 50 mm/ saat, C-reaktif protein (CRP) düzeyi 5,5 mg/L idi. Akne fulminans tanısı konularak sistemik izotretinoin tedavisi kesildi. 1 mg/kg oral prednizolon ve 300mg/gün klindamisin başlandı. Lezyonlarda gerileme görülen hastanın kortikosteroid tedavisi azaltılarak sonlandırıldı.

Keywords

Nodülokistik akne, akne fulminans, izotretinoin

Ethical Statement

Olgudan yazılı onam alınmıştır.

Supporting Institution

Bulunmamaktadır.

References

• Dessinioti, C. & Katsambas, A. (2017). Difficult and rare forms of acne. Clinics in dermatology, 35(2), 138–146. Durdu, M., Tehçi, T. & Karadag, A.S. (2022). Dramatic response to colchicine treatment in acne fulminans patients with cytological hemophagocytosis: A case series of 12 patients. Dermatologic therapy, 35(11), e15856.
• Gualtieri, B., Panduri, S., Chiricozzi, A., & Romanelli, M. (2020). Isotretinoin-triggered acne fulminans: a rare, disabling occurrence. Giornale italiano di dermatologia e venereologia: organo ufficiale, Societa italiana di dermatologia e sifilografia, 155(3), 361–362.
• Gutiérrez-Meré, R., Tajes, I., Diéguez, P., Soto-García, D., Martínez-Fernández, S. & Batalla, A. (2023). Acne Fulminans: A Narrative Review. Acné fulminans: revisión narrativa de la literatura. Actas dermo-sifiliograficas, 114(9), 763–771.
• Jansen, T., Romiti, R. & Plewig, G. (1999). Acute severe acne in a female patient (acne fulminans?). The British journal of dermatology, 141(5), 945–947.
• Karvonen S.L. (1993). Acne fulminans: report of clinical findings and treatment of twenty-four patients. Journal of the American Academy of Dermatology, 28(4), 572–579.
• Kelly, A.P. & Burns, R.E. (1971). Acute febrile ulcerative conglobate acne with polyarthralgia. Archives of dermatology, 104(2), 182–187.
• Massa, A.F., Burmeister, L., Bass, D. & Zouboulis, C.C. (2017). Acne fulminans: treatment experience from 26 patients. Dermatology (Basel, Switzerland), 233(2-3), 136–140.
• Perkins, W., Crocket, K.V., Hodgins, M.B., Mackie, R.M. & Lackie, J.M. (1991). The effect of treatment with 13-cis-retinoic acid on the metabolic burst of peripheral blood neutrophils from patients with acne. The British journal of dermatology, 124(5), 429–432.
• Plewig G. & Kligman A.M. (1975). Acne fulminans Acne. Berlin Springer-Verlag:342–51.
• Proença N.G. (2017). Acne fulminans. Anais brasileiros de dermatologia, 92(5 Suppl 1), 8–10.
• Walsh, R.K., Endicott, A.A. & Shinkai, K. (2018). Diagnosis and treatment of rosacea fulminans: a comprehensive review. American journal of clinical dermatology,19(1), 79–86.
• Zito, P. M., & Badri, T. (2023). Acne fulminans. In StatPearls. StatPearls Publishing.