Acne Fulminans

Overview

Acne fulminans is a very rare and severe form of acne that comes on suddenly. It causes painful, crusty sores on the skin, most often on the back, chest, and shoulders. It can also cause fever, aching joints, and a general feeling of being unwell.

No. Acne fulminans is very rare. Only a small number of cases are reported worldwide, and most doctors will only see a few cases in their entire career.

It almost always affects adolescent boys and young men, usually between the ages of 13 and 22. It can occasionally occur in girls or older adults, but this is very unusual.

Symptoms

Common symptoms

• Sudden appearance of painful, red nodules and plaques (larger, raised areas) on the back, chest, shoulders, and face.
• Ulcers that quickly become crusty and may bleed.
• Fever and chills.
• Severe joint pain, especially in the hips, knees, and shoulders.
• Extreme tiredness and a feeling of being generally unwell.
• Loss of appetite and weight loss.
• Enlarged lymph nodes (small, bean-shaped glands under the skin).

Symptoms in children

• Acne fulminans is very rare in children before puberty, but if it occurs, the symptoms are similar to those in teenagers: painful skin sores, fever, and joint aches.
• A child with these symptoms should see a doctor urgently for assessment and pain management.

Symptoms in older adults

• Acne fulminans is extremely uncommon in older adults.
• When it does occur, it may be linked to the use of male hormones (androgens) or certain medical conditions.
• Symptoms are generally the same, but the doctor will also check for other causes.

Causes

Main causes

• The exact cause is not known, but it appears to be an overreaction of the immune system to bacteria involved in acne, called Cutibacterium acnes.
• A sudden surge in male sex hormones (androgens) during puberty is likely involved.
• It is not caused by poor hygiene, eating chocolate, or any other lifestyle factor.

Risk factors

• Being male and in your teenage years or early twenties.
• Having a history of severe acne.
• Using anabolic steroids or other male hormones (this can trigger the condition).
• Having a family member with severe acne (a genetic risk).

When to see a doctor

See a doctor urgently if:

• If you or your child develops sudden, painful, crusty acne sores on the chest, back, or face, seek medical care that same day.
• If the sores are spreading rapidly or you have fever and joint pain, see a doctor urgently.

Book a routine appointment if:

• If you have acne that is suddenly becoming much more painful or deeper, make an appointment with your GP (general practitioner).

Diagnosis

A doctor usually makes the diagnosis by examining the skin and asking about your symptoms. Because acne fulminans is so rare, your doctor will likely refer you to a skin specialist (dermatologist) for confirmation and treatment.

Tests that may be done

• A blood test to check for inflammation and to look at your white blood cell count.
• A skin swab or biopsy (removing a tiny piece of skin) to rule out infection or other skin conditions.
• A joint examination if you have pain and swelling.

What to expect at your appointment

Your appointment may feel detailed. The doctor will ask about your medical history, any medicines you are taking, and how fast the acne appeared. You may need to have blood tests and see a specialist. It can feel overwhelming, but a clear diagnosis is the first step toward controlling the condition.

Treatment

Treatment for acne fulminans needs to be given quickly and is usually managed by a skin specialist. The main goals are to calm the rapid inflammation, prevent infection, and reduce the risk of severe scarring. Treatment is usually needed for several weeks or months.

Self-care at home

• Do not squeeze, pick, or scratch the sores — this can make scarring much worse.
• Gently wash the affected areas once or twice a day with a mild, fragrance-free cleanser.
• Take rest when you feel tired or have joint pain.
• Use a cool, clean compress on very painful areas if it feels soothing.
• Stop using any other acne products or treatments without checking with your doctor.

Medical treatments

Doctors typically use a combination of a strong anti-inflammatory medicine (a corticosteroid) taken by mouth, and a retinoid (a type of vitamin A derivative) under strict supervision. These medicines work together to stop the inflammation and heal the skin. If the sores are infected, an antibiotic may be added. The specialist will adjust the treatment based on how you respond and any side effects. Never start or stop such medicines without your doctor's advice.

When is surgery considered?

In very severe cases, pockets of pus (abscesses) may form under the skin. A minor procedure may be needed to drain them, but this is not common and is done by a specialist.

Living with this condition

Living with acne fulminans can be physically and emotionally challenging. You may need to take time off school or work during the worst phase. Try to keep a simple daily routine: take your medicines as prescribed, protect your skin from sun and harsh products, and talk to your doctor about any side effects.

Lifestyle tips

• Wear loose, soft cotton clothing to reduce friction and irritation over painful areas.
• Avoid heavy backpacks, tight straps, or anything that rubs against the sores.
• Keep your nails short and clean to reduce the chance of accidentally scratching the skin.
• Ask your doctor before using any over-the-counter acne products.

Diet and exercise

There is no special diet that can cure acne fulminans, but eating well helps your body recover. Gentle movement, like walking, may help with joint stiffness, but avoid vigorous exercise while the skin is very inflamed. Always ask your doctor what activity level is safe.

Mental health and emotional wellbeing

Having a sudden, painful, and visible skin condition can be very distressing. It is completely normal to feel anxious, sad, or embarrassed. These feelings are just as important as the physical symptoms. You deserve support, and talking to a counsellor or psychologist can help.

Prevention

There is no known way to prevent acne fulminans, because it is an unusual immune system reaction. However, treating severe acne early and avoiding anabolic steroids or unapproved hormone supplements may lower the risk in some people.

Complications

If left untreated

• Severe, permanent scarring of the skin, which can be deep and disfiguring.
• Joint pain that can last for months, and in rare cases, permanent joint or bone damage.
• Weight loss and poor nutrition due to feeling unwell.
• Infection of the open sores, which can spread to the bloodstream.

Long-term outlook

With prompt treatment from a specialist, the outlook is good. Most people improve significantly within weeks, though it can take months to fully heal. Scarring is common, but treatments exist to reduce its appearance once the condition has settled. Joint symptoms usually go away, and most people can live a full, healthy life.

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