Acne fulminans= العد الصاعق |
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Acne Fulminans
Acne fulminans (also known as acute febrile ulcerative acne) is the most severe form of nodular acne accompanied by systemic symptoms. The sudden appearance of massive, inflammatory, tender, oozing, friable plaques with hemorrhagic crusts characterize acne fulminans. The lesions predominate on the back and chest, rapidly become ulcerative, and heal with scarring. The disease is reported to occur primarily in teenage boys. The face is often not involved. The patients are febrile, have a leukocytosis of 10,000 to 30,000/mm3 white blood cells, and usually have polyarthralgia, myalgia, hepatosplenomegaly, and anemia. Bone pain is common, especially at the clavicle and sternum. Radiologic examination may demonstrate lytic bone lesions. Occasionally there is accompanying erythema nodosum. Although this disease is often classified with acne conglobata, there are basic differences. The onset of acne fulminans is more explosive, nodules and polymorphous comedones are less common, the face is not involved as frequently and the neck is usually spared, ulcerative and crusted lesions are unique, and systemic symptoms are more common. Systemic glucocorticoid therapy, along with oral antibiotics and intralesional glucocorticoids, is the treatment regimen required for these patients. Isotretinoin is also of benefit in these patients, but to prevent explosive flares, systemic glucocorticoids must be started before isotretinoin and continued during the first few weeks of isotretinoin therapy. The initial dosing of isotretinoin must also be lowered accordingly in the initial weeks of therapy until the inflammation is controlled. The daily dose of glucocorticoids should be slowly decreased as tolerated. Dapsone in conjunction with isotretinoin has been reportedly beneficial in the treatment of acne fulminans associated with erythema nodosum.
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