Acute severe acne in a female patient (acne fulminans?)

S ir, Acne fulminans is a rare but well characterized disorder consisting of a highly inflammatory form of acne associated with a variety of systemic features. 1 Although it is most commonly observed in male adolescents, it may rarely occur in female adolescents. A 15‐year‐old girl presented with a sudden outbreak of inflammatory and haemorrhagic nodulocystic lesions on the face, neck and upper trunk. The eruption began about 5 weeks earlier and was unresponsive to tetracycline 1·0 g daily. Examination on admission revealed multiple haemorrhagic subcutaneous nodules and cystic lesions with suppurative degeneration and necrotic debris ( Fig. 1). In addition, inflammatory nodules and pustules and a few comedones could be observed. The lesions affected the skin of the face, neck, upper chest and back. Physical and ultrasound examination showed no hepatosplenomegaly. She had slight fever up to 38 °C, but no arthralgia or myalgia were noticed. There was no history of recent bacterial or viral infections, gastrointestinal symptoms, menstrual irregularities, oral intake of halogenated drugs or vitamins. The eruption had developed suddenly over a couple of days and worsened progressively. The patient had had a mild form of papulopustular acne confined to the face for 1 year for which she had received no treatment. Both parents and the patient’s 18‐year‐old sister had suffered from a mild form of acne vulgaris in adolescence. Two younger brothers, aged 9 and 11 years, had no skin disorders.