Fulminant acne induced by simultaneous taking of isotretinoin and anabolic steroids

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.