[Fulminant acne: therapy with 13-cis-retinoic acid and indomethacin]

Young men with mild acne vulgaris may rarely experience a very acute exacerbation with ulceration and necrosis of the lesions accompanied by fever, malaise, loss of weight, often by polyarthritis, and occasionally by erythema nodosum. Elevated sedimentation rate and marked leucocytosis are characteristic; microhematuria is often observed. This condition has been called acne fulminans. We report on a young male patient suffering from severe acne fulminans. Systemic 13-cis retinoic acid (Roaccutan, Accutane) and indomethacine (Amuno) treatment rapidly improved the skin and joint lesions. Intracutaneous tests with viral, bacterial, and fungal antigens before and during treatment suggest a temporary cellular immune defect.