Diagnosis: Acne fulminans
Acne fulminans is an uncommon complication of acne. It was first described by Burns and Colville in 1959;1 Plevig and Kligman coined the term.2
Signs and symptoms. It is characterized by sudden onset ulcerative crusting cystic acne, mostly on the chest and back. Fever, malaise, nausea, arthralgia, myalgia, and weight loss are common.
Leukocytosis and elevated ESR are usually found. There may also be focal osteolytic lesions.
Thomson and Cunliffe suggest that the term acne fulminans may also be used in cases of severe aggravation of acne without systemic features.3
The cause of acne fulminans is not clear. However, alteration of type III and IV hypersensitivity to Propionibacterium acnes,4 circulating immune complexes,5 and increased cellular immunity6 have been found by some investigators.
Isotretinoin has been identified as a potential trigger.5 Some have suggested that isotretinoin increases the fragility of the pilosebaceous ducts, leading to massive contact with the P acnes antigen.