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Taudorf EH, Jensen MB, Bouazzi D, Sand C, Thomsen SF, Jemec GBE, Saunte DML. Tumor necrosis factor-α inhibitor treatment of acne fulminans - a clinical and literature review. J Dtsch Dermatol Ges 2024; 22:23-27. [PMID: 38128111 DOI: 10.1111/ddg.15234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/27/2023] [Indexed: 12/23/2023]
Abstract
Acne 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.
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Affiliation(s)
| | - Mikkel Bak Jensen
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Carsten Sand
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Taudorf EH, Jensen MB, Bouazzi D, Sand C, Thomsen SF, Jemec GBE, Saunte DML. Behandlung der Acne fulminans mit Tumornekrosefaktor-α-Inhibitoren - eine Übersicht klinischer Fälle und der Literatur: Tumor necrosis factor-α inhibitor treatment of acne fulminans - a clinical and literature review. J Dtsch Dermatol Ges 2024; 22:23-28. [PMID: 38212919 DOI: 10.1111/ddg.15234_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 07/27/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungAcne fulminans (AF) ist eine seltene, schwerwiegende, plötzlich auftretende und lang andauernde Hauterkrankung, die Vernarbungen im Gesicht und am Körper verursacht. Die Standardbehandlung mit langfristiger Verabreichung einer Kombination aus Isotretinoin und Prednisolon reicht nicht immer aus und kann unerwünschten Wirkungen haben. Es gibt daher einen ungedeckten Bedarf an besseren Therapien. Fallberichte lassen darauf schließen, dass Tumornekrosefaktor‐α (TNF‐α)‐Inhibitoren eine Rolle bei der Behandlung von AF spielen könnten. In einer 3 Jahre abdeckenden retrospektiven Datenerhebung aus zwei dermatologischen Zentren sowie einer Literaturübersicht klinischer Fälle von Acne fulminans, die mit Anti‐TNF‐α‐Therapie behandelt wurden, konnten drei klinische Fälle und zwölf Literaturfälle ermittelt werden. Insgesamt wurden fünf verschiedene TNF‐α‐Inhibitoren eingesetzt, am häufigsten Adalimumab. Klinisches Ansprechen wurde nach 1 Monat bei 2/3 (67%) der klinischen Fälle beziehungsweise 5/12 (42%) der Literaturfälle beobachtet. Nach einer medianen Dauer von 3–7 Monaten war die Behandlung bei 2/3 (67%) und 11/12 (92%) der Betroffenen erfolgreich. Alle berichteten unerwünschten Wirkungen waren leicht und reversibel. Die Anti‐TNF‐α‐Behandlung kann zu schneller Verbesserung bei Patienten mit AF führen, wenn die Erstbehandlung mit Isotretinoin und Prednisolon versagt. Allerdings fehlen randomisierte, kontrollierte Studien, und die exakte Dosierung sowie der exakte Zeitablauf müssen vor der klinischen Umsetzung genauer geprüft werden.
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Affiliation(s)
| | - Mikkel Bak Jensen
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
| | - Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
| | - Carsten Sand
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Kopenhagen, Dänemark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Kopenhagen, Dänemark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Kopenhagen, Dänemark
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital Roskilde, Roskilde, Dänemark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Kopenhagen, Dänemark
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Abstract
Acne fulminans (AF) is a rare and severe form of inflammatory acne presenting clinically with an abrupt outburst of painful, hemorrhagic pustules and ulceration, that may or may not be associated with systemic symptoms, such as fever, polyarthritis, and laboratory abnormalities. It typically affects male teenagers with a pre-existing acne. Although the pathogenetic mechanism has not been established yet, a role of genetic, abnormal immunologic response, drugs intake, hormonal imbalance and viral infection, as causal factors, has been identified. AF may occur as a single disease or may be associated with other disorders. Traditionally, AF has been classified, on the basis of the presence of systemic involvement, in "acne fulminans" and acne fulminans "sine fulminans," when no systemic involvement is present. Recently, four clinical variants have been proposed: acne fulminans with systemic symptoms (AF-SS), acne fulminans without systemic symptoms (AF-WOSS), isotretinoin-induced acne fulminans with systemic symptoms (IIAF-SS), isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS). The diagnosis of AF is usually based on clinical history and physical examination. No specific laboratory abnormalities are generally found. In selected cases, biopsy and/or radiologic imaging are helpful for a correct diagnosis. The treatment significantly differs from severe acne according to severity of clinical presentation and possible systemic involvement. Currently, systemic corticosteroids (prednisolone) and retinoids (isotretinoin) represent the first choice of treatment. Dapsone, cyclosporine A, methotrexate, azathioprine, levamisole, and biological agents such as anakinra, infliximab, adalimumab may be considered as alternative therapies in selected cases. Adjunctive topical and physical therapies may also be considered.
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Affiliation(s)
| | | | - Maria R Nasca
- Dermatology Clinic, University of Catania, Catania, Italy
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Bocquet-Trémoureux S, Corvec S, Khammari A, Dagnelie MA, Boisrobert A, Dreno B. Acne fulminans and Cutibacterium acnes phylotypes. J Eur Acad Dermatol Venereol 2020; 34:827-833. [PMID: 31715640 DOI: 10.1111/jdv.16064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acne fulminans (AF) is a rare and severe form of inflammatory acne. It is characterized by a sudden worsening of acne with appearance of ulceronecrotic lesions, which can be associated with systemic signs. Its pathophysiology and the best therapeutic strategy are only partially known. OBJECTIVE Our main objectives were to describe the clinical and biological profile of AF patients and to determine whether there was a difference in Cutibacterium acnes phylotype in AF compared to acne vulgaris. The secondary objective was to assess the efficacy of different therapies. METHODS A retrospective observational study was conducted in all patients followed for AF in our department between 2008 and 2018. Bacteriological samples were taken from each patient to analyse C. acnes phylotype distribution. The therapeutic response was assessed using the ECLA and GEA scales. RESULTS Fifteen patients with a median age of 15 years were included (12 men, 80%). A family history of acne was found in 86.7% of patients. Nine patients (60%) had isotretinoin-induced AF. Only one patient (6.7%) showed systemic signs. The bacteriological culture was positive for C. acnes in 80% of patients. The predominant phylotype was IA1 in 60% of patients, corresponding to the predominant phylotype in acne vulgaris. Only 33.3% of patients were in remission after a first-line treatment with systemic corticosteroids, alone or in combination. Seven patients were treated with biotherapy, including five successfully with secukinumab. CONCLUSION Our results suggest that there is no specific C. acnes phylotype associated with AF, raising the hypothesis that acute inflammation associated with AF may be more related to an abnormal cutaneous innate immunity activation. The use of preventive strategies, the impact of combined treatments and an assessment of the role of biotherapies, especially anti-IL-17, in AF treatment remain to be more investigated.
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Affiliation(s)
| | - S Corvec
- CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France.,Department of Bacteriology, CHU Nantes, Nantes, France
| | - A Khammari
- Department of Dermatology, CHU Nantes, Nantes, France.,CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
| | - M-A Dagnelie
- CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
| | - A Boisrobert
- Department of Dermatology, CHU Nantes, Nantes, France
| | - B Dreno
- Department of Dermatology, CHU Nantes, Nantes, France.,CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
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Successful Treatment of Facial Acne Fulminans: Antimicrobial Agents and Oral Prednisolone as Promising Regimes. Case Rep Dermatol Med 2017; 2017:7092910. [PMID: 28428896 PMCID: PMC5385906 DOI: 10.1155/2017/7092910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 02/28/2017] [Accepted: 03/16/2017] [Indexed: 11/21/2022] Open
Abstract
Acne fulminans (AF), also known as acne maligna, is a rare painful ulcerative form of acne with an abrupt onset and systemic symptoms. Its incidence appears to be decreasing, possibly because of earlier and better treatment of acne. This report highlights a case on a necrotizing facial wound due to AF that was successfully treated with oral prednisolone and antimicrobial medication.
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Draft Genome Sequence of an Erythromycin-Resistant Propionibacterium acnes Isolate Recovered from Folliculitis of the Scalp. GENOME ANNOUNCEMENTS 2017; 5:5/4/e01490-16. [PMID: 28126936 PMCID: PMC5270695 DOI: 10.1128/genomea.01490-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Propionibacterium acnes is now well-known and recognized for its implication in the pathogenesis of acne vulgaris. Here, we report the draft genome sequence of an erythromycin-resistant P. acnes strain isolated from a case of folliculitis of the scalp belonging to phylotype IA1 and sequence type 18 (ST18).
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Draft Genome Sequences of Four Propionibacterium acnes Strains Isolated from Implant-Related Infections. GENOME ANNOUNCEMENTS 2016; 4:4/6/e01395-16. [PMID: 27979946 PMCID: PMC5159579 DOI: 10.1128/genomea.01395-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Propionibacterium acnes was previously described as a potential implant-related pathogen. Here, we report the draft genome sequence of four P. acnes strains, isolated from spine material, hip arthroplasty, and knee arthroplasty infections in France belonging to different sequence types (ST18, ST27, and ST36).
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