Acne fulminans is a severe form of acne characterized by the rapid development of joint inflammation, fever and ulcerated or open acne lesions. (Reference 1) In some cases, individuals with this type of acne also develop blisters, bone inflammation or abnormal changes in bone structure. Management of acne fulminans symptoms typically requires the use of several different oral medications. (Reference 2)
Acne fulminans occurs in individuals who already have some form of inflammatory acne, according to the American Academy of Dermatology. In some cases, you may develop the disorder if you have undergone ineffective treatment for acne conglobata, a different type of severe acne characterized by serious skin damage and pockets of abscessed tissue beneath your skin. (Reference 1) You may also develop acne fulminans if you use testosterone supplements or the acne medication isotretinoin, the New Zealand Dermatological Society reports. (Reference 2)
The skin ulcerations associated with acne fulminans typically occur on your chest or back, according to the New Zealand Dermatological Society. In addition to the symptoms listed above, you may experience additional effects that include a general feeling of ill health, severe acne scarring, increases in your white blood cell count, weight loss and loss of appetite. (Reference 2) Joint pain and inflammation related to acne fulminans most frequently occur in your knees and hips, the American Academy of Dermatology reports. (Reference 1)
In some cases, you may develop a serious complication of acne fulminans called SAPHO, the New Zealand Dermatological Society notes. This syndrome involves any combination of symptoms that include synovitis, or joint inflammation; acne conglobata or acne fulminans; pustulosis, or the formation of thick, pus-filled blisters; hyperostosis, or abnormal increases in bone tissue; and osteitis, or bone inflammation. Typically, bone-related changes will occur in your sternum, resulting in symptoms that may include tenderness, swelling and pain-related loss of mobility. You may also experience enlargement of your collar bones and the formation of a type of bone abscess called sterile osteomyelitis. (Reference 3)
Acne Fulminans Treatment
Treatment for acne fulminans typically involves the management of symptoms, the New Zealand Dermatological Society explains. Because of the difficulties of symptom control, you may receive a number of medications, including dapsone, anti-inflammatories such as aspirin, oral steroids, isotretinoin and oral antibiotics. (Reference 2) In some cases, acne fulminans symptoms may recede and recur, the American Academy of Dermatology notes. If this occurs, your doctor may recommend extended use of isotretinoin. (Reference 1)
There are no drugs specifically designed to treat the symptoms of SAPHO, the New Zealand Dermatological Society reports. However, your doctor may adapt a number of medications for treatment, including methotrexate, infliximab, systemic or topical corticosteroids, colchicine and calcitonin. To treat your acne and pustulosis symptoms, your doctor may prescribe isotretinoin and a related compound called acitretin. If you experience joint damage, you may require treatment from a specialist called a rheumatologist. In some cases, the symptoms of SAPHO disappear over time. (Reference 3)
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