scholarly journals Adalimumab in the Management of Isotretinoin-Induced Acne Fulminans: Report of a Case

2021 ◽  
pp. 1-5
Author(s):  
Claudio Marasca ◽  
Gabriella Fabbrocini ◽  
Luisa Abategiovanni ◽  
Elisa Camela ◽  
Mariateresa Nocerino ◽  
...  
Keyword(s):  
Acne Vulgaris ◽  
Severe Form ◽  
Off Label ◽  
Oral Steroids ◽  
Acne Fulminans ◽  
Traditional Therapies ◽  
Systemic Symptoms

Acne fulminans (AF) is a rare, acute, and severe form of acne vulgaris often associated with systemic symptoms. Its treatment is challenging and controversial. We report a case of isotretinoin-induced AF (IIAF) in a 12-year-old boy resistant to traditional therapies (oral steroids and isotretinoin). The patient was successfully treated with adalimumab that can be considered an effective off-label option in the treatment of resistant IIAF in children.

scholarly journals Sacroiliitis after use of oral isotretinoin - association with acne fulminans or adverse effect?

2013 ◽  
Vol 88 (6 suppl 1) ◽  
pp. 193-196 ◽  
Author(s):  
Ariane Silva Bastos Geller ◽  
Roberta Ferreira Nazareth Alagia
Keyword(s):  
Adverse Effect ◽  
Back Pain ◽  
Acne Vulgaris ◽  
Severe Form ◽  
Sacroiliac Joints ◽  
Male Adolescents ◽  
Acne Fulminans ◽  
Oral Isotretinoin ◽  
Inflammation Resolution ◽  
Retinoid Treatment

Acne fulminans is a rare and severe form of acne that may evolve from acne vulgaris, especially in male adolescents, or occur as an adverse effect of oral isotretinoin. Arthritis is a serious clinical manifestation when the musculoskeletal system is compromised by AF and has been reported as a rare adverse effect of isotretinoin. Involvement of the sacroiliac joints occurs in 21% of acne fulminans cases. We present the case of a 18-year-old male patient in whom acne fulminans evolved from acne vulgaris grade IV and after inflammation resolution started treatment with oral isotretinoin. Within a 30-day period of retinoid treatment he presented with back pain followed by rapid, progressive inability to deambulate.

scholarly journals Hidradenitis suppurativa and acne vulgaris and conglobata—systematic review and meta-analysis

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kevin Phan ◽  
Olivia Charlton ◽  
Saxon D. Smith
Keyword(s):  
Systematic Review ◽  
Hidradenitis Suppurativa ◽  
Meta Analysis ◽  
Acne Vulgaris ◽  
Management Strategies ◽  
Case Control Studies ◽  
Summary Effect ◽  
Acne Fulminans ◽  
Inflammatory Skin Disorder

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata. Methods The present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic. Results From pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%). Conclusions In summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.

scholarly journals A57 VALPROATE INDUCED DRESS SYNDROME CAUSING MIXED LIVER INJURY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 67-68
Author(s):  
R Schneider ◽  
R Verstegen ◽  
J Hulst ◽  
S Ito ◽  
V Ng
Keyword(s):  
Liver Injury ◽  
Early Recognition ◽  
Oral Steroid ◽  
Fatty Acid Transport ◽  
Dress Syndrome ◽  
Elevated Liver Enzymes ◽  
Oral Steroids ◽  
Synthetic Function ◽  
Sick Children ◽  
Systemic Symptoms

Abstract Background Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome occurs with 1 in every 1,000 to 10,000 drug exposures and has a mortality rate of up to 10%. It is one mechanism by which medications can induce liver injury with elevated liver enzymes seen in the majority of cases. In children, aromatic anticonvulsants are the drugs most commonly associated with DRESS syndrome. Valproate, a non-aromatic anti-epileptic, is not known to have a heightened risk of hypersensitivity syndromes and is often the anti-epileptic of choice in patients who develop hypersensitivity syndromes from other anti-epileptics. Valproate hepatotoxicity is normally caused by its inhibition of fatty acid transport and mitochondrial β-oxidation; vanishing bile duct syndrome is also reported. Aims We present a case, to the best of our knowledge the first in paediatrics, in which valproate causes DRESS syndrome and a secondary, predominantly cholestatic, liver injury. Methods Literature review and case report. Results A previously healthy 14-year-old girl was diagnosed with new-onset seizures and started on valproate. Three weeks later, she developed a pruritic exanthem. Despite discontinuing her valproate, the rash persisted and she developed fever and jaundice. She was admitted to the ICU at the Hospital for Sick Children with a diagnosis of DRESS syndrome (RegiSCAR DRESS score 7) for treatment with IV steroids. At admission, she had a skin eruption, fever, leukocytosis (22.86 x109/L), eosinophilia (1.03x109/L), atypical lymphocytes (1.62 x109/L), lymphadenopathy, and internal organ involvement (BiliC 138, GGT 501, INR 1.3, ALT 543, AST 370, Crt 109). Of note, her EBV PCR was positive. By discharge, her rash improved and kidney function normalized. Her cholestasis persisted, despite improvement in her transaminases and eosinophilia (BiliC 163, INR 1.0, GGT 338, ALT 506, AST 220, Eos 0.98x109/L). She was discharged home on an oral steroid wean, ursodeoxycholic acid, levocarnitine, and levetiracetam. Upon reaching a daily dose of 20mg of prednisone, her rash and pruritus worsened, she had lost 7kg, and she was readmitted for IV steroids. Her rash improved within 4 days and she was discharged on a slower steroid taper, with the addition of cholestyramine and insulin for steroid induced diabetes. At present (2 ½ months after diagnosis), she continues her oral steroids and has persistent liver injury and pruritus. Conclusions We report the first paediatric case of valproate induced DRESS syndrome causing a significant cholestatic presentation with otherwise preserved liver synthetic function. The prolonged cholestasis and pruritus may be a result of the natural course of DRESS syndrome, EBV reactivation/infection, or polypharmacy. Early recognition of DRESS syndrome as a mechanism of valproate induced liver injury in children is essential for earlier diagnosis and initiation of targeted therapy. Funding Agencies None

scholarly journals Reactivation of Old Scars in an Elderly Man Revealing Löfgren's Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Vishnu Vardhan Reddy Munagala ◽  
Vaishali Tomar ◽  
Amita Aggarwal
Keyword(s):  
Rare Case ◽  
Erythema Nodosum ◽  
Febrile Illness ◽  
High Resolution Computed Tomography ◽  
Short Course ◽  
Oral Steroids ◽  
Hilar Adenopathy ◽  
Löfgren’S Syndrome ◽  
Systemic Symptoms ◽  
Noncaseating Granulomas

Here, we report the case of a 55-year-old man with reactivation of old cutaneous scars associated with a febrile illness, episcleritis, polyarthralgias, erythema nodosum and hilar adenopathy. High-resolution computed tomography (HRCT) revealed right paratracheal, bilateral hilar, and subcarinal lymphadenopathy without any nodular densities in both lung fields. A scar biopsy revealed multiple noncaseating granulomas and confirmed the diagnosis of sarcoidosis. A short course of oral steroids led to regression of systemic symptoms, and the scars returned to baseline size. This patient represented a rare case of simultaneous Löfgren’s syndrome and scar sarcoidosis.

scholarly journals Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone as Promising Regimes

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Amir Hossein Siadat ◽  
Anis Bostakian ◽  
Bahareh Abtahi-Naeini ◽  
Masoom Shahbazi
Keyword(s):  
Successful Treatment ◽  
Antimicrobial Agents ◽  
Oral Prednisolone ◽  
Abrupt Onset ◽  
Facial Wound ◽  
Acne Fulminans ◽  
Systemic Symptoms ◽  
Facial Acne

Acne fulminans (AF), also known as acne maligna, is a rare painful ulcerative form of acne with an abrupt onset and systemic symptoms. Its incidence appears to be decreasing, possibly because of earlier and better treatment of acne. This report highlights a case on a necrotizing facial wound due to AF that was successfully treated with oral prednisolone and antimicrobial medication.

scholarly journals Acne fulminans in a Vietnamese boy successfully treated with prednisolone and ibuprofen: A case report

2018 ◽  
Vol 5 (9) ◽  
pp. 2708-2711
Author(s):  
Quang Van Vu
Keyword(s):  
Delayed Diagnosis ◽  
Severe Infection ◽  
Rare Condition ◽  
Severe Form ◽  
Rapid Improvement ◽  
Case Presentation ◽  
Reactive Protein ◽  
Acne Fulminans ◽  
Systemic Manifestations ◽  
First Time

Background: Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by the emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. Here, we report for the first time a Vietnamese boy with Acne fulminans successfully treated with prednisolone and ibuprofen. Case presentation: The patient is a 14-year-old male teenager with moderate acne since the age of 13. After a day of swimming, his acne suddenly became inflamed and painful lesions were present on his face and back. He had high fever and polyarthritis, and tests showed leukocytosis, neutrophilia, and elevated C-reactive protein (CRP). Severe infection was diagnosed and treated by addition of antibacterial therapy for a long period, however, the condition did not improve. When called upon to evaluate the patient, we established the diagnosis of acne fulminans and initiated treatment with prednisone (1mg/kg/day) and ibuprofen (500 mg for two times daily). Following this treatment regimen, there was a rapid improvement. Conclusion: Herein, we have reported a Vietnamese boy with typical AF, but delayed diagnosis and treatment because of a rare condition. Our results support the role and benefit of prednisolone for AF treatment.

scholarly journals Acne fulminans successfully treated with prednisone and dapsone

2012 ◽  
Vol 87 (4) ◽  
pp. 612-614 ◽  
Author(s):  
Rafael Bandeira Lages ◽  
Sebastião Honório Bona ◽  
Flávia Veríssimo Melo e Silva ◽  
Andressa Karoline Lima Gomes ◽  
Viriato Campelo
Keyword(s):  
Oral Prednisone ◽  
Rare Condition ◽  
Poor Response ◽  
Sudden Onset ◽  
Severe Form ◽  
Acne Fulminans ◽  
The Face

Acne fulminans is a rare condition and the most severe form of acne. It involves the sudden onset of febrile and multisystemic symptoms, with poor response to ordinary therapy in patients who previously had mild to moderate acne. It is characterized by hemorrhagic ulcerative crusting lesions on the face, chest and upper back. The authors report a case of acne fulminans that was successfully treated with oral prednisone and dapsone.

scholarly journals DRESS: clinicopathological features of 10 cases from an University Hospital in São Paulo

2012 ◽  
Vol 87 (5) ◽  
pp. 703-707 ◽  
Author(s):  
Luciane Francisca Fernandes Botelho ◽  
Viviane Shinsato Higashi ◽  
Maria Helena Valle de Queiroz Padilha ◽  
Milvia Maria Simões e Silva Enokihara ◽  
Adriana Maria Porro
Keyword(s):  
Drug Reaction ◽  
Liver Function Tests ◽  
Sao Paulo ◽  
Severe Form ◽  
University Hospital ◽  
São Paulo ◽  
Drug Induced ◽  
Culprit Drug ◽  
Systemic Symptoms ◽  
Induced Reaction

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction with multiorgan involvement. OBJECTIVES: The aim of this study is to evaluate the epidemiological, clinical and pathological features and prognosis of this drug reaction among patients seen at a dermatology service. METHOD: Retrospective review of medical records of ten patients diagnosed with drug reaction with eosinophilia and systemic symptoms at the Federal University of São Paulo, from august 2008 to may 2011. RESULTS: Phenytoin was the leading cause of drug reaction with eosinophilia and systemic symptoms in our cases, followed by allopurinol. Abnormal liver function tests were observed in 7 patients and renal function impairment in 2 patients. In all cases, patients were hospitalized and the culprit drug was withdrawn. The main treatment was systemic corticosteroid. Drug reaction with eosinophilia and systemic symptoms resulted in death in 2 cases. The causes of death were septic shock and hepatic failure. CONCLUSION: Our mortality rate of 20%, supports that drug reaction with eosinophilia and systemic symptoms is a severe form of drug-induced reaction and must be recognized by all dermatologists.

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