Acute acne flare-up during isotretinoin therapy – case reports

Introduction . Acne fulminans (AF) is the most severe type of acne, which is very rare and mainly occurs in boys aged 13-16 years. Administration of isotretinoin for therapy of acne can precipitate AF. The cause of AF remains obscure; an excessive immunological reaction against antigens that are released from destroyed Propionibacterium acnes cells has been suggested.

Objective . To report 3 cases of AF which developed at the beginning of isotretinoin treatment of severe acne.

Case report . We present 3 patients who developed AF within the first 2 months after administration of oral isotretinoin. Skin lesions in all patients consisted of haemorrhagic ulcers filled with gelatinous, necrotic debris forming layered crusts. They were accompanied by severe arthralgia, myalgia, fever and abnormal laboratory findings, but no other serious complications such as osteolytic bone lesions or osteomyelitis were noticed. After administration of systemic glucocorticosteroids, rapid clearance of acute symptoms was observed.

Conclusions . Acne fulminans is rare in patients treated with systemic isotretinoin. However, clinicians should be aware of the risk of its occurrence in order to provide appropriate therapy.