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What Is Acne Fulminans?

By Andy Josiah
Updated Mar 03, 2024
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Acne fulminans (AF) is a severe yet rare form of the skin disease acne, which is named after the suddenness of its occurrence and the severity of its impact. The cause of acne fulminans is usually attributed to a type of bacterium called Propionibacterium acnes, which are antigens that some members of the medical community believe weakens the immune system and consequently allows AF to occur. The production or increase of Propionibacterium acnes is often linked to high levels of anabolic steroids and testosterone. In some cases, it may develop from the unsuccessful treatment of acne conglobate itself. Other theories of the disease’s precipitation include genetic factors and infectious diseases like measles. Acne fulminans can also occur independent of any disease or factors.

Besides the fever present with acne conglobata, acne fulminans is characterized by polyarthritis, or inflammation of the joints as well as lymph nodes swelling at the base of the neck. These signs can make movement, particularly of the limbs and neck, very painful and difficult to execute. Some people might also experience difficulty breathing as well as open sores on their torso, which are prone to scarring and infection. In later stages, the patient experiences weight, appetite and muscle loss in addition to further deterioration of physical ability. AF is most common among males between the ages of 13 and 22 who have a history of acne.

Historically, acne fulminans is an exceedingly rare disease; only about 100 cases were reported within a period of 50 years after its first description. Currently, the most common treatment of AF is a combined prescription of oral steroids and isotretinoin. Medicated soaps such as Dermisil™ are also popular among patients. The recurrence of AF after treatment is very rare.

Its discovery is commonly traced to 1958, when a pair of physicians with the last names of Burns and Colville attended the Detroit Dermatological Society with a teenage boy who had acute febrile as well as acne conglobata, which is also a skin disease. Acute febrile disease is chiefly characterized by a fever. Acne conglobata is a severe case of acne in which comedones, or blackheads, and ulcers are among the common signs.

This was the first time that such a case was made public. For a while, the combination of the two aforementioned diseases was called acute febrile ulcerative acne conglobata, or acute febrile ulcerative acne. Acne fulminans, however, was eventually differentiated from acne conglobata due to the comparatively sudden and severe nature of the disease, which means that it is fulminant. Indeed, the “fulminans” suffix of AF is derived from the aforementioned adjective.

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