title: Acne fulminans and erythema nodosum during isotretinoin therapy responding to dapsone.
abstract: Acne vulgaris is very common, 85% of teenagers being affected at any one time. In most cases, the disease is mild and patients do not present to the dermatologist. Most are instead treated with over-the-counter products and conventional treatment such as peeling agents or topical and systemic antibiotics. Isotretinoin has revolutionized the treatment of severe acne unresponsive to oral antibiotics. Explosive and very severe acne such as pyoderma faciale, acne conglobata and acne fulminans are rare, the features that distinguish acne fulminans from the other conditions being systemic upset with fever, joint pain, malaise and leucocytosis, while there have been two reports of the condition associated with erythema nodosum. The recommended treatment for acne fulminans is a combination of oral steroids and systemic antibiotics, isotretinoin probably not being the treatment of choice. We now report a patient who developed acne fulminans and erythema nodosum within 3 weeks of starting isotretinoin and then responded to dapsone without oral steroids.
authors.affiliation: Department of Dermatology, Central Outpatients, Stoke-on-Trent, UK.
authors.forename: B B
authors.initials: BB
authors.lastname: Tan
authors.forename: J T
authors.initials: JT
authors.lastname: Lear
authors.forename: A G
authors.initials: AG
authors.lastname: Smith
mesh_terms: D000152:Acne Vulgaris / Q000139:chemically induced / Q000188:drug therapy*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use*; D004893:Erythema Nodosum / Q000139:chemically induced*; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects*; D007641:Keratolytic Agents / Q000009:adverse effects*; D008297:Male; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D007641:Keratolytic Agents; D003622:Dapsone; D015474:Isotretinoin