Fulminant acne induced by simultaneous taking of isotretinoin and anabolic steroids

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Abstract

Acne fulminans is a rare disease characterized by the sudden appearance of painful nodules with a pronounced tendency to ulceration, accompanied by general symptoms, including fever, arthralgia, hepatomegaly and impaired blood parameters. Among its most frequent triggers are anabolic steroids and isotretinoin.

The article describes a patient whose disease was caused by the sequential administration of anabolic steroids and systemic isotretinoin. The clinical picture of acne fulminans in the patient was represented by typical skin rashes, changes in blood parameters, arthralgia and myalgia, as well as nodular erythema. Systemic antibacterial therapy with doxycycline was ineffective. The patient was hospitalized in the Saint Petersburg State Budgetary Healthcare Institution "City Dermatovenerological Dispensary", where he was treated with prednisone and then with systemic isotretinoin. Due to the severe course of the process, the cumulative dose of isotretinoin achieved 240 mg/kg. Against the background of treatment, studies of aspartate aminotransferases, alanine aminotransferases, bilirubin, cholesterol, triglyceride indicators were regularly conducted, the values of which did not exceed the limits of reference indicators. The remission of the disease was 3 years, there are residual phenomena in the form of scars. Scar correction is carried out using a fractional CO2 laser (SmartXide Touch), no more than 3% of the skin is treated in one procedure.

The peculiarity of the observation presented by us is the association of fulminant acne with simultaneous administration of steroid hormones and isotretinoin, the combination of fulminant acne with erythema nodosum, as well as good tolerance of high doses of isotretinoin.

The literature review discusses data on etiopathogenesis, features of clinical manifestations, approaches to the treatment of fulminant acne. Modern approaches to the classification of the disease are also presented.

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About the authors

Irina O. Smirnova

Saint-Petersburg State University; City Dermatovenerological Dispensary

Email: driosmirnova@yandex.ru
ORCID iD: 0000-0001-8584-615X
SPIN-code: 5518-6453

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Alla V. Sukhenko

City Dermatovenerological Dispensary

Email: allasyxenko42@gmail.com
ORCID iD: 0000-0003-3653-1826
SPIN-code: 6258-6701

 

 

Russian Federation, Saint Petersburg

Yanina G. Petunova

Saint-Petersburg State University; City Dermatovenerological Dispensary

Email: yaninapetunova@yandex.ru
ORCID iD: 0000-0002-6489-4555
SPIN-code: 5853-9630

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Natalia V. Shin

Saint-Petersburg State University

Email: shinataly2@gmail.com
ORCID iD: 0000-0002-8138-1639
SPIN-code: 3343-8607

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Saint Petersburg

Kristina D. Khazhomiya

Saint-Petersburg State University

Author for correspondence.
Email: christinakhazhomiya@gmail.com
ORCID iD: 0000-0002-2997-6109
SPIN-code: 2796-4870
Russian Federation, Saint Petersburg

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2. Fig. 1. The clinical picture of fulminant acne before treatment is multiple drainage nodes that tend to decay with the formation of ulcerative defects covered with serous-hemorrhagic crusts resembling gelatin masses (а–с), nodule on the anterior-inferior surface of the tibia with weak erythema (d).

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3. Fig. 2. The clinical picture of fulminant acne at the end of the course of treatment is multiple hypertrophic scars, single nodes with decay (а–с).

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4. Fig. 3. Clinical picture after 3 years: а–с ― the effect of correction of hypertrophic scars using fractional CO2 laser (SmartXide Touch, Italy).

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