J Am Acad Dermatol 2017 Jul;77(1):109-117

University of California, San Diego, California; Rady Children's Hospital-San Diego, San Diego, California.

Background: Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence-based information and no clear guidelines concerning the classification and treatment of AF. Read More

Case Rep Dermatol Med 2017 27;2017:7092910. Epub 2017 Mar 27.

Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Acne fulminans (AF), also known as acne maligna, is a rare painful ulcerative form of acne with an abrupt onset and systemic symptoms. Its incidence appears to be decreasing, possibly because of earlier and better treatment of acne. This report highlights a case on a necrotizing facial wound due to AF that was successfully treated with oral prednisolone and antimicrobial medication. Read More

Clin Dermatol 2017 Mar - Apr;35(2):138-146. Epub 2016 Oct 27.

Department of Dermatology, Andreas Syggros Hospital, University of Athens, 5, Dragoumi str, 16121, Athens, Greece.

Acne is the most common of skin diseases, being characterized as a chronic inflammatory disease of the pilosebaceous unit. Although acne is usually straightforward to diagnose and treat, some patients have difficult or rare forms of acne. What seems to be "nonresponding acne" in a patient may be caused by another acneiform disease that clinically mimics acne, thus misleading the clinician, if not ruled out, with scrutiny. Read More

Reumatol Clin 2016 Dec 16. Epub 2016 Dec 16.

Unidad de Gestión Clínica de Pediatría, Hospital Universitario San Cecilio, Granada, España.

The acronym of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) combines a cluster of cutaneous and musculoskeletal manifestations, such as hyperostosis of bones of the anterior chest wall associated with acne fulminans and hidradenitis suppurativa. There are no validated diagnostic criteria in children. Nonsteroidal anti-inflammatory drugs are not always sufficient, and the use of corticosteroids, disease-modifying agents, tumor necrosis factor-α inhibitors or bisphosphonates may be necessary. Read More

An Bras Dermatol 2016 Sep-Oct;91(5):706

Pontificia Universidad Católica de Chile - Santiago, Chile.

J Eur Acad Dermatol Venereol 2017 Jun 14;31(6):e277-e279. Epub 2016 Nov 14.

Division of Dermatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Indian Dermatol Online J 2016 Sep-Oct;7(5):414-417

Department of Dermatology, Bhaskar Medical College, Telangana, India.

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a rare inflammatory disorder, is an association of distinct skin disorders with pustules with osteoarticular inflammation. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. An 18-year-old male patient presented to the outpatient department with severe nodulocystic acne on the face with pain at both the wrists and lower back associated with high-grade fever and chills. Read More

Pediatr Dermatol 2016 Nov 4;33(6):e388-e392. Epub 2016 Oct 4.

Department of Dermatology, Necker Enfants-Malades Hospital, Paris, France.

Acne fulminans (AF) is a rare manifestation and the most severe form of the entire clinical spectrum of acne. The disease is destructive and is characterized by the sudden onset of painful and ulcerative pustules and systemic symptoms including high fever, hepatomegaly, polyarthralgia, leukocytosis, plaquetose, and increased inflammatory markers and transaminases. Osteolytic lesions in multiple skeletal sites could also be associated. Read More

G Ital Dermatol Venereol 2016 Oct;151(5):553-7

Section of Dermatology, Department of Medical Sciences, S. Anna Hospital, Ferrara University Hospitals, Ferrara, Italy -

Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Read More

Dermatol Ther 2016 Nov 21;29(6):476-478. Epub 2016 Jun 21.

Department of Dermatology and.

Indian Dermatol Online J 2016 Mar-Apr;7(2):93-5

Department of Dermatology, Army College of Medical Sciences, Base Hospital, Delhi, India.

Acne fulminans (AF) is a very rare severe form of acne seen in young males, characterized by a sudden and explosive onset of hemorrhagic pustules and ulceration on the trunk, systemic features in the form of fever, polyarthropathy, malaise, erythema nodosum and painful osteolytic bone involvement with leukocytosis, and an elevated erythrocyte sedimentation rate. Conventional treatment of AF includes corticosteroids or immunosuppressive agents for the initial phase followed by isotretinoin. Active hepatitis B infection with a high viral load precludes the administration of any immunosuppressive drugs. Read More

Int J Dermatol 2016 May 29;55(5):571-3. Epub 2015 Dec 29.

Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea.

Rom J Morphol Embryol 2015 ;56(3):1185-90

Department of Dermatology, University of Medicine and Pharmacy of Craiova, Romania;

Acne fulminans is the most aggressive and destructive form of acne vulgaris, being also known as acne maligna. The onset is acute and systemic involvement is always present. Most commonly, acne fulminans (AF) occurs in male adolescents as a brutal complication of a preexisting mild or moderate acne. Read More

J Am Acad Dermatol 2015 Nov;73(5 Suppl 1):S66-9

Institut Pasteur, Medical Center, Paris, France. Electronic address:

Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. Read More

Indian Dermatol Online J 2015 Jul-Aug;6(4):253-7

Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. Read More

Zhonghua Kou Qiang Yi Xue Za Zhi 2015 Feb;50(2):110-2

Email:

Infection 2015 Oct 29;43(5):595-7. Epub 2015 Jan 29.

Department of Pathophysiology and Transplantation, Institute for Treatment and Research Cà Granda Ospedale Maggiore Policlinico Foundation, Università degli Studi di Milano, Via Pace 9, 20122, Milan, Italy.

We report a case of severe Citrobacter koseri folliculitis of the face in a boy with acne. A 15-year-old boy affected by acne was admitted because of a rash located on the face. Dermatological examination revealed two large plaques, with numerous pustules, eschars and crusts, located bilaterally and symmetrically on the cheeks. Read More

JAAD Case Rep 2015 Jan 18;1(1):27-9. Epub 2014 Oct 18.

Department of Dermatology, University Hospital Hôtel-Dieu, Nantes, France; INSERM U892, University Hospital Hôtel-Dieu, Nantes, France.

J Am Acad Dermatol 2015 Mar 12;72(3):550-3. Epub 2014 Aug 12.

Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Electronic address:

Key teaching points • Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is characterized by distinctive osteoarticular manifestations and a spectrum of neutrophilic dermatoses. • The most common dermatologic manifestations include palmoplantar pustulosis, acne conglobata, and acne fulminans. • SAPHO syndrome should be considered in patients presenting osteoarticular pain, particularly involving the anterior chest wall and/or spine, and neutrophilic skin lesions. Read More

Isr Med Assoc J 2014 Jun;16(6):393-4

An Bras Dermatol 2014 Jul-Aug;89(4):657-9

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Acne fulminans is a rare and serious condition characterized by the sudden onset of nodular and ulcerative acne lesions associated with systemic symptoms. It has been recognized a subset of patients with a sudden worsening of acne, often during treatment with oral isotretinoin, but without the strong presence of systemic involvement. Recognized by some authors as "pseudo-acne fulminans" or " acne fulminans sine fulminans," we report a case with these features in order to draw attention to the recognition and early management of this manifestation. Read More

J Am Acad Dermatol 2014 Feb;70(2):e38-9

Department of Dermatology Hospital Clínic, University of Barcelona, Spain.

An Bras Dermatol 2013 Nov-Dec;88(6 Suppl 1):193-6

Fundação de Dermatologia e Venereologia Alfredo da Matta, ManausAM, Brazil.

Acne fulminans is a rare and severe form of acne that may evolve from acne vulgaris, especially in male adolescents, or occur as an adverse effect of oral isotretinoin. Arthritis is a serious clinical manifestation when the musculoskeletal system is compromised by AF and has been reported as a rare adverse effect of isotretinoin. Involvement of the sacroiliac joints occurs in 21% of acne fulminans cases. Read More

Dermatol Ther 2013 Jul-Aug;26(4):367-9. Epub 2013 Apr 12.

Dermatology Unit, Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy.

Acne fulminans, the most severe form of acne, comprises ulcerative nodulocystic lesions with general, abdominal, and skeletal symptoms acute in onset. In our case, the patient initially had been managed as acute appendicitis. Antibiotic therapy had been administered in full doses with systemic corticosteroids, usually recommended as primary treatment. Read More

JAMA Dermatol 2013 Feb;149(2):209-15

Division of Immunology, Allergy, and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

Background: Pyogenic sterile arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome (OMIM 604416) is a rare autosomal dominant inherited autoinflammatory syndrome characterized by pyogenic sterile arthritis and less frequently accompanied by pyoderma gangrenosum and acne. It is associated with dominant missense mutations in the proline-serine-threonine phosphatase-interacting protein 1 gene (PSTPIP1) located on chromosome 15. The patient was diagnosed as having features of a PAPA-like syndrome in which cutaneous manifestations, such as pyoderma gangrenosum and acne fulminans, predominated. Read More

Rev Med Chil 2012 May;140(5):637-9

Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain.

Background: Rosacea fulminans is a rare condition, characterized by a sudden onset of papulopustules, cysts, edema, and draining sinuses usually confined to the facial area. It is often accompanied by low-grade fever, myalgias and leukocytosis. Patients usually have a background of mild rosacea. Read More

Arch Dermatol 2012 Oct;148(10):1210-2

An Bras Dermatol 2012 Jul-Aug;87(4):612-4

Medicine School, Federal University of Piaui, Teresina, Brazil.

Acne fulminans is a rare condition and the most severe form of acne. It involves the sudden onset of febrile and multisystemic symptoms, with poor response to ordinary therapy in patients who previously had mild to moderate acne. It is characterized by hemorrhagic ulcerative crusting lesions on the face, chest and upper back. Read More

An Bras Dermatol 2011 Jul-Aug;86(4 Suppl 1):S46-9

Ambulatório de Dermatologia Pediátrica, Hospital Municipal Jesus, Rio de Janeiro, Brasil.

The authors report a case of SAPHO Syndrome, in pediatric age, with a dermatological focus. This entity should be considered in patients who have pain in the anterior chest wall or other musculoskeletal symptoms, accompanied by palmoplantar pustulosis and acne fulminans. The specific cutaneous manifestations, diagnosis and the treatment will be presented. Read More

An Bras Dermatol 2011 Jul-Aug;86(4 Suppl 1):S9-12

serviço de Dermatologia, Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brasil.

Acne fulminans is a rare manifestation that may occur during the evolution of acne vulgaris primarily in male adolescents. Use of isotretinoin, testosterone, and exacerbated immune responses in the body are related triggers. Signs, symptoms and laboratory findings such as fever, hepatomegaly, polyarthralgia, leukocytosis, plaquetose, increased inflammatory markers and transaminases, are characteristic. Read More

An Bras Dermatol 2011 Sep-Oct;86(5):983-5

Serviço de Dermatologia de Presidente Prudente, São Paulo, Brasil.

Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. It can be induced by isotretinoin and some authors believe that the occurrence of this condition is dose dependent. Read More

Eur J Dermatol 2011 Sep-Oct;21(5):794-5

Dermatology 2011 30;222(3):231-5. Epub 2011 Apr 30.

Department of Dermatology, Shiga University of Medical Science, Otsu, Shiga, Japan.

A 19-year-old Japanese man had been treated for ulcerative colitis for 2 years. He was admitted to our hospital with nodulocystic inflammatory papules and pustules on his face and chest, high-grade fever, arthralgia and general malaise. A biopsy specimen from a pustule showed prominent infiltration of neutrophils in the epidermis and dermis, particularly around hair follicles. Read More

Acta Derm Venereol 2011 May;91(3):337-8

J Eur Acad Dermatol Venereol 2011 May 3;25(5):501-7. Epub 2010 Oct 3.

Department of Dermatology, Poznan University School of Medical Sciences, Poznan, Poland.

Acne fulminans (AF) is a rare severe form of acne vulgaris associated with systemic symptoms. It primarily affects male adolescents. Although the aetiology of AF remains unknown, many theories have been advanced to explain it. Read More

Br J Dermatol 2010 Oct;163(4):877-9

Int J Dermatol 2010 Mar;49(3):331-3

Institute of Dermatological Science, University of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.

Background: Acne fulminans is the most severe form of inflammatory acne characterized by the acute onset of inflammatory nodules and plaques, most commonly on the chest and the back. The lesions undergo rapid suppuration, leaving ragged hemorrhagic ulcers. Typically, it affects adolescent males with a history of mild to moderate acne. Read More

Clin Exp Dermatol 2010 Dec;35(8):888-91

Department of Core Medicine, Bristol Royal Infirmary, United Bristol Healthcare Trust, Bristol, UK.

Rosacea fulminans (RF) is a rare facial dermatosis characterized by the sudden onset of severe facial inflammation consisting of numerous pustules, cystic swellings and coalescing sinuses. The standard treatment is the retinoid drug isotretinoin in combination with systemic corticosteroids or with high-dose oral tetracycline antibiotics. We report three recent cases of RF in pregnancy with differing obstetric outcomes: an intrauterine death, a termination of pregnancy, and a normal vaginal delivery. Read More

J Dermatol 2009 Aug;36(8):471-3

Clin Exp Dermatol 2009 Oct 14;34(7):e241-3. Epub 2009 Mar 14.

Ann Dermatol Venereol 2008 Oct 24;135(10):675-8. Epub 2008 Jul 24.

Dermatologie, université François-Rabelais, CHRU de Tours, Tours cedex 09, France.

Background: Rosacea fulminans is a rare and severe form of rosacea, with acute onset in women between 20 and 40 years. Although the aetiology remains unknown, pregnancy has been reported to be a triggering factor. We report a case of rosacea fulminans occurring at the onset of pregnancy and discuss a possible triggering role of endocrine factors, as well as therapeutic options. Read More

J Dtsch Dermatol Ges 2007 Feb;5(2):110-7

Department of Dermatology, Environmental Medicine and Health Science, Division of Human Sciences, University of OsnabrYck, Germany.

Abuse of anabolic-androgenic steroids (AAS) by members of fitness centers and others in Germany has reached alarming dimensions. The health care system provides the illegal AAS to 48.1 % of abusers. Read More

S D Med 2006 Sep;59(9):387-9

Sanford School of Medicine of The University of South Dakota, Yankton Model Program, USA.

Acne Fulminans (AF) is a severe form of cystic acne primarily affecting Caucasian adolescent males. The systemic clinical manifestations of the disease make it likely that the patient will present to his or her primary care provider rather than to a dermatologist. Promptly recognizing this disorder will aid in appropriate management, avoiding costly and invasive diagnostic procedures, multiple consultations, unnecessary pharmacologic treatments, and residual scarring of the skin. Read More

J Clin Rheumatol 2002 Feb;8(1):13-22

Department of Medicine, Rhode Island Hospital, The Miriam Hospital, Providence, Rhode Island, USA.

Synovium and synovial fluid findings in SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome have not been well characterized, and only a few patients have been described in the Americas. We describe clinical, pathologic, and synovial fluid findings in 12 patients with the SAPHO syndrome: hidradenitis suppurativa (7), acne fulminans or conglobata (3), acneiform folliculitis (1) and palmoplantar pustulosis (1). Routine synovial fluid studies were performed in 6 patients, and light and transmission electron microscopic studies were performed in synovium in 2 patients and in bone in 1. Read More

Hautarzt 2005 Nov;56(11):1018-26

Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie der Universität Essen.

Acne is a very common dermatosis with characteristic clinical features. It is a polymorphic disease. The clinical expression ranges from non-inflammatory closed and open comedones to inflammatory papules, pustules, and nodules. Read More

J Drugs Dermatol 2005 Jul-Aug;4(4):501-5

Department of Dermatology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany.

We report on a 12-year-old boy suffering from acne fulminans in combination with Marfan syndrome. The trigger for acne induction seemed to be a testosterone therapy. The particular therapeutic problems in the present case are described. Read More

J Am Acad Dermatol 2005 May;52(5 Suppl 1):S118-20

Department of Medicine, Harbor-UCLA Medical Center, UCLA School of Medicine, Torrance 90502, USA

Acne fulminans is a syndrome of sudden onset hemorrhagic and ulcerative acne involving the back, chest, and face combined with systemic symptoms. It can be the dermatologic manifestation of the synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. Current therapy for acne fulminans consists of wound care, topical and systemic corticosteroids, isotretinoin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Read More

Int J Dermatol 2005 Feb;44(2):132-3

Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.

Acne fulminans is a syndrome of fulminant, necrotizing acne associated with bone lesions, constitutional symptoms, and laboratory abnormalities. A case report of an adolescent male with acne fulminans following withdrawal of isotretinoin and prednisone is presented. Read More

Rev Med Chir Soc Med Nat Iasi 2004 Apr-Jun;108(2):319-24

Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Clinica Dermatologică.

The etiology and pathogenesis of acne vulgaris are not yet completely understood. Therefore we have investigated 5 patients with different clinical forms of disease, including the rare form of acne fulminans. Taking into consideration the four factors that are currently incriminated in the development of acne, sebaceous hypersecretion, hyperkeratosis of the pilosebaceous infundibulum, bacterial colonisation and perifollicular inflammation, we have focused our study on a set of cells involved in the chronic inflammatory process. Read More

Clin Dermatol 2004 Sep-Oct;22(5):412-8

University of Athens, School of Medicine, Department of Dermatology, A Sygros Hospital, Athens, Greece.

Acne vulgaris is a disease affecting mostly adolescents and young adults that, when severe, has the potential to result in scarring and permanent disfigurement. Systemic treatment is necessary to prevent significant psychological and social impairment in these patients.(1) Significant inflammatory and nodulocystic acne is usually recalcitrant to topical treatment, whereas uncommon acne variants, such as acne fulminans, pyoderma faciale, and acne conglobata, need to be promptly and effectively controlled. Read More