Evidence-based recommendations for the management of acne fulminans and its variants

J Am Acad Dermatol. 2017 Jul;77(1):109-117. doi: 10.1016/j.jaad.2016.11.028.


Background: Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence-based information and no clear guidelines concerning the classification and treatment of AF.

Objective: To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research.

Methods: A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5-hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations.

Results: Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus.

Limitations: Limited evidenced-based data and prospective studies in the literature concerning the treatment of AF is available.

Conclusion: These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants.

Keywords: PAPA; PAPASH; SAPHO; acne fulminans; diagnosis; isotretinoin; pseudotumor cerebri syndrome; treatment.

Publication types

  • Review

MeSH terms

  • Acne Vulgaris / classification
  • Acne Vulgaris / drug therapy*
  • Evidence-Based Medicine
  • Humans
  • Practice Guidelines as Topic