Acne Fulminans

Key Points

Refers to a rare and severe form of acne with abrupt onset, fever, malaise, and joint pain. Aggressive therapy is necessary usually with antibiotics, systemic steroids, and isotreinoin.

Characterized by whiteheads(closed Comedones), blackheads(open Comedones), and inflamed red pustules(pimples), and occasionally deeper cysts or nodules

Factors leading to Acne include: 1. Elevated sex hormone levels causing overactive sebaceous glands with resultant increased Sebum production 2. Comedone(pore blockage) formation 3. Overgrowth of P. acnes bacteria

Commonly appears on the face and shoulders

Most common in teenagers, but can occur at any age. The higher levels of sex hormones during puberty are the initiating factor leading to increased sebum(oil) production.

Acne is a very common skin condition in which pores become clogged with sebum(oil) and keratin(skin cell components). This is most often triggered by an increase in the production of sex hormones during puberty; however, Acne may occur at any age. The plugged pores(Comedones) are more prone to overgrowth of the skin bacteria, P. acnes, which will often result in inflammatory papules, pustules, nodules or cysts(pimples or zits). Acne often runs in families and may be triggered by hormonal changes related to menstruation, pregnancy, birth control or stress. Acne may be triggered by the use of oily cosmetic products, the use of certain drugs including steroids, hormone replacements, and phenytoin, or being exposed to high levels of humidity and sweating.

The blockage of the pore, called the plug or comedone, can manifest in several different ways. It may appear light (whitehead) or dark (blackhead). If the plug ruptures, the material inside may spread to the surrounding skin, causing it to become inflamed. Inflammation deep in the skin tissue can lead to the formation of cysts. Acne can also lead to facial scarring or changes in skin color.

Differential Diagnosis (Other conditions with similar appearance)
Rosacea (lacks Comedones)
Perioral Dermatitis
Acneiform Drug eruptions

Diagnosis
Key Points
Diagnosis based on skin appearance
Testing is not required

Acne is generally diagnosed based on appearance, then further graded by severity, based on the number of total lesions. Under 30 total lesions is considered mild, with a moderate case consisting of 30 to 125 lesions. Severe cases can consist of greater than 125 lesions or the appearance of more than 5 cysts in the affected area.

Treatment

Many treatment options exist, though there is no cure for Acne
Self care, including cleaning and avoiding contact with affected areas, can lessen the effects of Acne
Health care professionals may prescribe topical or oral treatments in moderate or severe cases

OTC Options: Acne medications containing Benzoyl peroxide, sulfur, resorcinol, or Salicylic acid

While there is no cure for acne, many treatment options exist to lessen its effects. Self care options include keeping the affected areas clean with a mild, non-drying soap, keeping hair (especially if oily) clean and out of the face, avoiding touching or squeezing the pimples, and avoiding oil based cosmetics. If self care does not lessen the occurrence to the desired level, OTC topical Acne medications (many containing Benzoyl peroxide or Salicylic acid) can help by killing bacteria, drying excess oil, and causing breakdown of the comedone(comedolysis).

In resistant or severe cases, health care professionals may prescribe stronger topical medications and even orally administered treatment options. Options such as topical antibiotics and Tretinoin, and prescription strength versions of OTC treatments can help to alleviate severe Acne as well as orally administered options, including antibiotics (Minocycline, Doxycycline, Tetracycline) and Accutane (Isotretinoin).