Poster 2, Acne fulminans: part of the spectrum of SAPHO

Abstract

A 13‐year‐old boy was admitted to hospital with severe back pain and systemic upset. He had commenced isotretinoin 25 mg (0·5 mg kg–1) daily 17 days previously for severe acne unresponsive to oral erythromycin. Isotretinoin was stopped after 4 days due to severe lower back pain. On admission, he was unable to mobilize and the pain was uncontrolled with oral morphine sulphate. Investigations showed leucocytosis and neutrophilia. Magnetic resonance imaging of the vertebrae showed multiple areas of high signal consistent with an inflammatory process such as osteomyelitis. Oral prednisolone 40 mg daily and ibuprofen controlled the pain within 2 days. Sulfasalazine (1 g twice daily) was commenced 10 days later. The re‐introduction of isotretinoin 5 mg daily 12 days after admission precipitated severe back pain, necessitating 3 days of intravenous methylprednisolone. The oral prednisolone dose has been reduced over 6 weeks and stopped. The acne is currently controlled with clindamycin, although there is marked scarring. Acne fulminans is a rare condition characterized by sudden onset of severe acne and systemic features such as fever, leucocytosis and arthralgia.1 Osteomyelitic lesions are a recognized feature. In 1987, the term SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome was proposed to describe a clinical entity with skin, joint and bone manifestations. Associated skin conditions include severe acne, psoriasis and palmoplantar pustulosis. Reported sites of osteoarticular involvement include the anterior chest wall, vertebrae, pelvis and mandible.2 Our patient clearly has acne fulminans and fulfils the criteria for SAPHO syndrome. We believe this condition will be increasingly recognized by dermatologists. 1 Karvonen S. Acne fulminans: report of clinical findings and treatment of twenty‐four patients. J Am Acad Dermatol 1993; 28:572–9. 2 Hayem G, Bouchaud‐Chabot A, Benali K et al. SAPHO syndrome: a long‐term follow‐up study of 120 cases. Semin Arthritis Rheum 1999; 29:159–71.