Acne Fulminans: A Case Report of 18Y/M
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An 18-year-old male presented with multiple painful pustules and weeping ulcers with hemorrhagic crusting over few lesions over both cheeks and forehead along with the development of cysts. This was accompanied by fever, arthralgia, and lethargy. The patient was admitted for supervision. Complementary investigations revealed leukocytosis with neutrophilia and elevated erythrocyte sedimentation rate (ESR). Radiographic imaging revealed no bone involvement.

A history of oral isotretinoin intake for acne for 14 days before the onset of symptoms was present. A diagnosis of acne fulminans (AF) was made, and oral isotretinoin was withheld, suspecting it as a trigger. Oral prednisolone (1 mg/kg) was instituted. Oral amoxicillin-clavulanic acid 1 g twice daily for 7 days, potassium permanganate compresses twice daily, oral paracetamol, and aceclofenac were added. The cysts were drained and liquid nitrogen cryotherapy was done on nodules.

Oral prednisolone was tapered over 3-month duration in which the patient showed considerable improvement with no symptoms or signs of relapse. Isotretinoin was re-introduced at 20 mg/day after 4 weeks of starting oral steroids and was continued for 5 months, during which the lesions did not flare. At the 12th month follow-up after discontinuation of oral isotretinoin, the patient did not report any new lesions.

Source: https://www.ijpd.in/article.asp?issn=2319-7250;year=2021;volume=22;issue=1;spage=43;epage=47;aulast=Bhatia
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