Acne fulminans is a rare form of acne, characterized by the appearance of rapidly ulcerating nodular or papular acne on the skin of the trunk. The disease is accompanied by a pronounced violation of general well-being in the form of fever, joint pain, appetite disorders, etc. Diagnosis is carried out according to typical clinical symptoms. Inflammatory changes are detected in the blood test, and blood culture, as a rule, does not give results. Acne fulminans requires systemic medication in combination with local therapy.
To date, dermatology cannot accurately name the causes of such a severe form of acne as acne fulminans. They suggest a toxic-allergic or infectious-allergic mechanism of their development. It is known that chronic inflammatory diseases contribute to the occurrence of the disease: ulcerative colitis, Crohn’s disease, chronic gastritis, hepatitis, chronic bronchitis, pyelonephritis, etc. Some patients note the connection of the disease with the use of tetracycline antibiotics, treatment with isotretinoin for vulgar acne or therapy with other synthetic retinoids.
Often, acne fulminans appears against the background of an already existing mild form of acne with nodular cystic or papulo-pustular types of acne. The disease is characterized by a sudden onset with the occurrence of ulcerative necrotic rashes and a sharp violation of general well-being. The appearance of acne fulminans is accompanied by a rise in body temperature to 38 ° C and above, severe muscle pain, arthralgia, anorexia, abdominal pain.
The elements of the rash are usually located on the skin of the chest, shoulders, back, side of the neck, without affecting the face. They are a lot of ulcerated acne in the form of nodules or papules. Such elements are located on a hyperemic background and are combined with pustular rashes. Because of this clinical picture, some dermatologists consider acne fulminans similar to gangrenous pyoderma. The resolution of the elements occurs with the formation of scars.
The diagnosis is established by the characteristic elements of the rash, the rapid onset of the disease and the presence of significant changes in the general condition of the patient. The blood test determines accelerated ESR, leukocytosis and a decrease in hemoglobin. Backfilling of blood for sterility, as a rule, gives a negative result. To determine the sensitivity of the pathogenic microflora, back-seeding of the ulcerated elements separated from the surface is carried out.
In order to identify and treat concomitant chronic pathology, the patient may be prescribed a consultation with a gastroenterologist, pulmonologist or urologist, as well as additional studies: gastroscopy, irrigoscopy, colonoscopy, lung x-ray, bronchography, ultrasound of the kidneys and bladder, urography, etc.
The general therapy of acne fulminans consists in prescribing antibiotics (doxycycline, erythromycin, clindamycin, etc.), taking into account the sensitivity of the isolated microflora to them. Anti-inflammatory drugs are used: ibuprofen, nemisulide, etc. If acne fulminans occurs in women, a consultation of a gynecologist-endocrinologist is required to resolve the need for therapy with estragens or antiandrogens.
Local treatment consists in lubricating the affected areas of the skin with gels and ointments with antibacterial drugs, retinoids, keratolytics. Of the physical methods of treatment, laser therapy, phototherapy, ozone therapy and mesotherapy, small doses of UVI are used.