Acne fulminans, also known as acne maligna, is a severe skin disorder that manifests as ulcerating, hemorrhagic, and often painful acne lesions. While this is a very rare condition, affecting only a tiny percentage of the global population, acne fulminans treatment requires significant medical intervention. Acne fulminans most often occurs in young men, but there have been isolated cases reported in women. Unlike other forms of acne which manifest mostly on the face, forehead, chest, upper back, and shoulders, acne fulminans appears only on the trunk of the body.
In addition to presenting as painful lesions, acne fulminans can be exceedingly difficult to treat. Dermatologists do not have a full understanding of the disease’s etiology. It may be resistant to even the most advanced antibiotic treatments typically provided to acne patients.
Acne Fulminans Symptoms
Symptoms of acne fulminans are very distinct. The condition causes extensive inflammatory lesions in the dermis with necrosis of follicles and overlaying epidermis, often followed by severe scarring of the dermal tissue. The condition itself appears as several inflammatory nodules, especially on the trunk. The nodules themselves are painful to the touch and ulcerated, typically covered in crusts.
In addition to presenting as painful lesions, acne fulminans is accompanied by a range of additional symptoms. This includes pain and inflammation in the joints, the sudden onset of severe acne scarring, and a loss of appetite, which can lead to severe weight loss. People with acne fulminans may also experience the following symptoms:
- Fluctuating Fever
- Ulcerated and crusted lesions
- A gradual decline in muscles, thus inhibiting physical abilities.
- Enlarged liver and spleen
- Unresponsive to antibacterial therapy
Clinical tests reveal a lower hemoglobin count synonymous with anemia, and an upsurge in the number of white blood cells, the erythrocyte sedimentation rate (ESR), and amount of C-reactive proteins. Further, X-ray screening reveals osteolytic bone lesions.
Causes and Risk Factors for Acne Fulminans
Doctors do not know the exact cause of acne fulminans, but dermatologists believe that certain immune system deficiencies are responsible. Acne fulminans has also been associated with increased levels of androgen, a male hormone, which explains why it is more commonly found in men. There is also a factor of genetic predisposition, though the pattern of inheritance is not known.
Unlike ordinary acne, which affects teenagers across all races, studies have shown that acne fulminans predominantly occurs in young white males from 13 to 22 years old. Studies have also shown that individuals with prior experiences with acne are more susceptible to developing acne fulminans. The condition is sometimes precipitated by the unsuccessful treatment of acne vulgaris with isotretinoin. Acne fulminans can also be accelerated by the use of testosterone and anabolic steroids, acquired legally for medical purposes or illegally, to induce muscle growth.
Other lifestyle factors, such as the use of alcohol, eating spicy food, and excessive exposure to sunlight or heat, can also influence this condition and its severity.
Acne Fulminans Treatment
Acne fulminans requires a sophisticated and systemic administration of antibiotics, glucocorticoids, and retinoids. You will need to see a doctor to diagnose the condition and receive acne fulminans treatment. Often, it starts with systemic corticosteroids and the use anti-inflammatory medicines, like aspirin. If secondary infections appear, your doctor may prescribe a high dose of a separate oral antibiotic. The administration of isotretinoin and prednisolone has proven to resolve systemic symptoms and improve skin lesions in 65% of patients at about a month of treatment.
That said, the acne fulminans treatment that works for you may be completely unique. Your dermatologist will work with you to develop a strategy that works for your skin and condition.
When to See a Doctor for Acne Fulminans
Acne fulminans will almost always cause permanent scarring of the skin with visible patches on the affected areas. Patients may also experience a change in mobility and body posture because of internal changes, as acne fulminans can affect the bones and muscle tissues. Emotionally, the condition might leave a patient with very low self-esteem brought about by scarring of the skin.
Unlike regular acne that is self-treatable and self-diagnosable, acne fulminans is chronic. Patients should immediately see a board-certified dermatologist, like those who work at the Skin Care Center of Southern Illinois, at the onset of symptoms. If you want to know if you’re experiencing acne fulminans, contact us to schedule a consultation.