Acne Fulminans triggered by Isotretinoin: another element to add in the Controversy

• Acne fulminans is the presence of very severe inflammatory acne lesions (nodules…) accompanied by systemic symptoms such as fever, joint pain.
• This is the most severe form of acne and requires the use of systemic steroids.
• Acne vulgaris is a common skin condition and can be mild, moderate or severe. Treatment is stepwise and starts with topicals, systemic antibiotics and isotretinoin.
• Isotretinoin is usually prescribed too easily, as some tend to forget the serious implications of taking this medication.

• Here is another reason to become more cautious of doing this; the authors report the development of acne fulminans:
  • in a 17 year old male
  • known for nodulocystic acne for 2 years
  • taking 0,8 mg/Kg/d of isotretinoin orally
  • the systemic symptoms began in the second month of treatment: fever, chest pain, muscle tenderness.
  • Skin examination showed haemorrhagic, tender, crusted nodules on the face and upper chest.
  • lab results: leucocytosis, elevated ESR, elevated CRP, elevated liver enzymes (AST, ALT)
  • Treatment with high dose oral prednisolone (60mg/Kg/d was required)

• Conclusion: although isotretinoin is a treatment of acne including more severe forms, authors suggest it could trigger acne fulminans.

Source of information: 2014 (03) – Karaman G, Acne fulminans triggered by isotretinoin therapy. 72nd AAD (American Academy of Dermatology) Annual Meeting (Denver, CO, United States of America)