Tumor necrosis factor‐α inhibitor treatment of acne fulminans – a clinical and literature review

Abstract

SummaryAcne fulminans (AF) is a rare, serious, sudden‐onset and long‐lasting skin disease that causes scarring of face and body. Standard treatment with combined long‐term isotretinoin and prednisolone is not always sufficient and has a well‐known propensity for adverse effects leaving an unmet need for improved therapy. Case reports suggest that tumor necrosis factor (TNF)‐α inhibitors may play a role in the management of AF. In a 3‐year retrospective data collection from two dermatology centers and literature review of clinical cases of acne fulminans treated with anti‐TNF‐α therapy, three clinical cases and twelve literature cases were identified. A total of five different TNF‐α inhibitors have been tested, with adalimumab being the most commonly used. Clinical response was seen after 1 month in 2/3 (67%) clinical cases and 5/12 (42%) literature cases, respectively, and treatment was successful in 2/3 (67%) and 11/12 (92%) after a median 3–7 months. All reported adverse effects were mild and reversible. Anti‐TNF‐α treatment may provide rapid improvement in patients with AF when initial treatment with isotretinoin and prednisolone fails. However, randomized controlled trials are lacking, and exact dosage and timing need to be explored before clinical implementation.