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J Rheumatol 2020 Apr 1. Epub 2020 Apr 1.

From the Department of General Pediatrics, Pediatric Infectious Diseases and Pediatric Rheumatology, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris APHP, Paris, France, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris, France; Université Paris Diderot-Sorbonne Paris-Cité, INSERM, UMR1149, Paris, France; Biology and Genetics of Bacterial Cell Wall Unit, Institut Pasteur, Paris, France; Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Paris, France; Department of Dermatology, Hôpital Saint-Louis, Paris, France Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases (RAISE), Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France. Address correspondence to Ulrich Meinzer, MD, PhD, Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Auto-immune diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France. Email:

Objective: Acne fulminans (AF) is a rare, explosive systemic form of acne. Chronic non-bacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is a primarily pediatric autoinflammatory disorder characterized by sterile osteolytic bone lesions. Concomitant occurrence of CNO/CRMO and AF is very rare and little is known about the epidemiological and clinical particularities of this association. Read More

Photodiagnosis Photodyn Ther 2020 Mar 20;29:101630. Epub 2019 Dec 20.

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

In this work, we present a case of deteriorative acne that occurred during methylprednisolone and danazol treatment of idiopathic thrombocytopenic purpura (ITP). Treatment of the patient with a combination of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and isotretinoin was satisfactory, though the patient had platelets as low as 4-10 × 10/L during treatment. We consider that the combination of oral isotretinoin and ALA-PDT was effective in this patient may be due to the synergetic effect of these treatments. Read More

J Eur Acad Dermatol Venereol 2020 Apr 16;34(4):827-833. Epub 2020 Jan 16.

Department of Dermatology, CHU Nantes, Nantes, France.

Background: Acne fulminans (AF) is a rare and severe form of inflammatory acne. It is characterized by a sudden worsening of acne with appearance of ulceronecrotic lesions, which can be associated with systemic signs. Its pathophysiology and the best therapeutic strategy are only partially known. Read More

Acta Derm Venereol 2020 Jan 23;100(1):adv00036. Epub 2020 Jan 23.

Department of Dermatology and Venerology, University Hospital of Brest, FR-29200 Brest, France.

Cutis 2019 Jun;103(6):E20-E21

Department of Dermatology, Venereology, and Allergology, Medical University of Gdańsk, Poland.

Indian J Dermatol Venereol Leprol 2019 Jul 11. Epub 2019 Jul 11.

One Center for Rheumatology and Genetics, Trivia Complex, Natubhai Circle, Vadodara, Gujarat, India.

A 19-year-old man with granulomatosis with polyangiitis (Wegener's disease) presented with hemorrhagic facial nodules mimicking severe inflammatory acne (acne fulminans) as one of the first symptoms of the disease. The lesions were earlier treated as nodulocystic acne with isotretinoin without any benefit. Complete resolution was seen with pulsed methylprednisolone and oral prednisolone and mycophenolate mofetil thereafter. Read More

Eur J Dermatol 2019 Aug;29(4):438-439

Dermatology Department, Amiri Hospital-Ministry of health, Kuwait Omariya-, P.O box:49185, 85152 Kuwait.

JAAD Case Rep 2019 Jun 8;5(6):525-528. Epub 2019 Jun 8.

Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France.

J Dtsch Dermatol Ges 2019 08 6;17(8):837-838. Epub 2019 May 6.

Department of Dermatology, University Hospital of Jena, Jena, Germany.

Indian Dermatol Online J 2018 Nov-Dec;9(6):462-464

Department of Dermatology, R.N.T. Medical College, Udaipur, Rajasthan, India.

G Ital Dermatol Venereol 2018 Sep 18. Epub 2018 Sep 18.

Dermatology Department, University of Pisa, Pisa, Italy.

Clin Cosmet Investig Dermatol 2018 3;11:403-405. Epub 2018 Aug 3.

Department of Dermatology, University of Pisa, Pisa, Italy,

Acne fulminans (AF) is a rare acne variant characterized by sudden onset of painful nodules on the face, chest, and back in the presence of systemic symptoms. Pharmacologic agents such as steroid hormones and isotretinoin are well-known triggers, and several cases have been described. We report a case of AF occurring a few days after lymecycline therapy initiation. Read More

Cutis 2017 Dec;100(6):E23-E26

Department of Pediatrics, Department of Medicine, Division of Dermatology and Cutaneous Sciences, University of Alberta, Edmonton, Canada.

Acne fulminans is an uncommon and debilitating disease that presents as an acute eruption of nodular and ulcerative acne lesions in association with systemic symptoms. It occurs commonly during treatment of severe acne (eg, acne conglobata) with isotretinoin in young adolescent male patients. Isotretinoin and doxycycline also can potentially induce development of neutrophilic dermatoses in patients with severe acne lesions, which are characterized by the acute appearance of painful ulcerative papulonodules accompanied by systemic symptoms including fever and leukocytosis. Read More

Pediatr Dermatol 2018 Mar 4;35(2):257-258. Epub 2018 Jan 4.

Department of Dermatology, School of Medicine, Yale University, New Haven, CT, USA.

Acne fulminans is a severe form of acne characterized by painful, inflammatory nodules that progress into ulcers and concurrent systemic symptoms. Treatment of acne with isotretinoin can precipitate a syndrome called isotretinoin-induced acne fulminans without systemic symptoms. An exuberant granulation tissue response, another known adverse event associated with isotretinoin, can occur concurrently, inhibiting wound repair and complicating treatment. Read More

Indian J Dermatol Venereol Leprol 2018 Jan-Feb;84(1):104-107

Department of Dermatology, Zagazig University, Zagazig, Egypt.

An Bras Dermatol 2017 ;92(5 Suppl 1):8-10

Private practice - Campos do Jordão (SP), Brazil.

Acne fulminans is a rare and severe variant of acne. In Brazilian medical journals, cases are infrequently reported, confirming its rarity. We followed five young male patients with this severe variant of cutaneous lesions, accompanied by also severe systemic symptoms: fever, anorexia, weight loss, and arthralgia. Read More

Dermatology 2017 29;233(2-3):136-140. Epub 2017 Jul 29.

Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Dessau, Germany.

Background /Aim: Acne fulminans is a rare form of acne vulgaris with acute clinical deterioration including systemic signs. Etiopathogenesis and management remain largely unknown. Our aim is to assess the efficacy of a combined therapeutic regimen of systemic isotretinoin and prednisolone following the recent concepts of acne pathogenesis and drug kinetics. Read More

G Ital Dermatol Venereol 2019 Feb 13;154(1):84-85. Epub 2017 Jul 13.

First Division of Dermatology, Istituto Dermopatico dell'Immacolata, Rome, Italy.

Am J Clin Dermatol 2018 Feb;19(1):79-86

Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA, 94115, USA.

Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Read More

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 2018 Mar - Apr;14(2):109-112. 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