Acne Fulminans Treated with Oral Retinoids

Area of Science:

• Dermatology
• Internal Medicine

Background:

• Acne fulminans is a rare, severe variant of acne vulgaris characterized by sudden onset of inflammatory nodules, ulceration, and systemic symptoms.
• Typical management includes systemic corticosteroids, but some cases exhibit resistance to standard treatments.

Observation:

• A 22-year-old male presented with a 4-year history of severe nodulo-cystic acne and scarring.
• The patient also exhibited systemic signs including fever, malaise, polyarthralgia, weight loss, and leukocytosis, consistent with acne fulminans.
• Initial treatment with routine therapies and systemic corticosteroids yielded no improvement.

Findings:

• Low-dose oral isotretinoin was administered due to treatment resistance.
• Dramatic clinical improvement in acne lesions and systemic symptoms was observed within two weeks of initiating isotretinoin.
• No relapse occurred during an 18-week follow-up period, indicating sustained efficacy.

Implications:

• Low-dose oral isotretinoin represents a viable and effective therapeutic option for recalcitrant acne fulminans.
• This treatment approach can lead to rapid symptom resolution and long-term disease control.
• Further research into optimal dosing and long-term outcomes of isotretinoin in acne fulminans is warranted.