What trigger acne fulminars ?

 WHAT IS ACNE FULMINANS ?

Acne fulminanas know as acute febrile ulcerative acne is a severe form of the skin disease , acne , which can occur after  unsuccessful treatment for another  form of acne , acne conglobata . the condition is thought to be an immunologically  induced disease in which  elevated level of testosterone causes a rise in sebum and population of Cutbacterium acnes bacteria . The increase  in the  amount od C acnes or related antigens may trigger the immunologic reaction in some  individual   and lead to an occurrence of acne fulminars . Acne fulminars  is a rare disease. The past several years , fewer cases  of this  disease  have occured , possibly  related  to  highly  increased  levels of C acnes antigens in the patients immune system . Over the past several years , fewer cases of this disease have occured , possibly because  of earlier and better treatment of acne . Approximately 100 patients with acne fulminars have been described . 


HOW TO TREAT  ACNE FULMINANS  ?

Treatment should be  sought  immediately in order to avoid  hospitalization . Hospitalization  for an extended period of time is likely .  the patients is tested  for signs of systems  degradation , especially of the skeletal structure and the digestive  tract . This time open sores  will  develop  on the upper torso . Some will be the size of dimes, other  will be  large enough  to stick  a couple finger into . It is recommended  to sleep  on one's sides until  the cystic  condition subsides , in order  to avoid any uncomfortable situation . Bone lesion  typically resolve with treatment , but residual  radiographic changes , such as  sclerosis and hyperostosis  may remain . Scarring and fibrosis may result from this acute  inflammatory process . Acne filminans  predominantly  affects young  males aged 13 to 22 years with a history of acne . Successful treatment with Antimicrobical Agents and Oral Prednisolone . 


SIGN & SYMPTOMS OF ACNE FULMINANS :

Acne filminans begins as pain and inflammation in the joints . it eventually progresses into a swelling of the lymph  nodes located at athe base of the neck, , causing  inflexibility  in the neck  within  weeks after the nodes  swell . This swelling will  eventually  decrease , but this decrease will be  accompanied by an increased inflammation and swelling of the joint  as well as  complete loss of appetite , though  these symptoms are often ignored . A fter some times , the disease will cause an extreme loss of weight and atrophy of the muscles , leading to the decline of physical abilities . 

PICTURES OF ACNE FULMINANS :








WHAT ARE CAUSES OF ACNE FULMINANS :

Acne fulminans has been associated  with increased  androgens , autoimmune complex disease and genetic predisposition . It may be related to an explosive hypersensitivity reaction to surface bacteria . Acne fulminans may be precipited  by :

- Testosterone and anabolic steroid 

- Oral isotretinoin 

The syndrome SAPHO [ synovitis , acne , pustulosis , hyperostosis  and osteitis ] may be a serious complication of acne fulminans . 


ACNE FULMINANS IN A FEMALE :

Acne fukminans is a rare but well characterized  disorder  consisting of a highly inflammatory form of acne associatedd with a variety  of systemic features . It is most  commonly  observed in male  adolescents . it may rarely  occur  in female  adolescents . Thee eruption  began about 5 week earlier  and was   unresponsive to tetracycline  1.0g daily .  In addition  inflammatory  nodules and pustules  and a few  comedones  could be observed .  the lesion  affected the skin of the face , neck , upper chest and back . There was no history  of recent  bacterial or viral infection , gastrointestional symptoms  menstrual irregularities , oral intake  of halogenated  drugs or vitamins .

Acne fulminans is a rare form of extremely severe cystic  acne that occurs in female and primarily  in teenage boys . it is characterized by highly inflammatory nodules  and plaques that undergo  swift  suppurative inflammatory nodules  and plaques that undergo swift suppurative  degenration , leaving ragged ulcerations with hemorrhagic crusts, mostly  on the chest and back . The face is usually less severely  involved . Commonly  systemic signs and symptoms  may accompany acne fulminans.  Prednisone is necessary during the initial 4-8 wweks to heal  the dramatic lesions of acne  fulminans. Isotretinoin  induced the flare, it must be discontinued  during this phase . after resolution  of the  inflammation  10- 20 mg daily of isotretinoin is added . Large cysts may be opened and the contents expressed .  Intralesional corticosteroids and dapsone are alternatives if isotretin is contraindicated . 

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