Acne fulminans
Introduction
Introduction to fulminant acne Acnefulminans (acnefulminans) is a rare form of acne. It is a sudden-prone acne-like pustule with a tendency to spread. It occurs in the upper back, chest, face and neck. Most of the patients are young males, often accompanied by fever. , joint pain and other systemic symptoms. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific people Mode of infection: non-infectious Complications: scleritis
Cause
Cause of fulminant acne
(1) Causes of the disease
The exact cause of the disease is still not very clear. Some people think that it is a type III or type IV allergy of acne propioni, because the normal parasite in the hair follicle can cause immune disorders, immune complexes increase, complement reduction, -sphere The protein is increased, and fever, joint pain, bone lesions and other symptoms appear. It has also been reported that AF patients are related to allergies. Some people have found that 0.5% to 12% of myeloid cells, anterior myelocytes and myelocytes are in the peripheral blood of patients. It is thought to be caused by taking corticosteroids.
In order to find the cause of fever, except for the presence of bacteremia, blood bacteriological culture is often performed on patients, all of which are negative. The bone biopsy of osteomyelitis AF patients only sees non-specific inflammation, no pathogenic bacteria, bacterial culture at the lesions, No other pathogens, more common are normal parasites.
(two) pathogenesis
The exact pathogenesis is still not very clear. Some people think that it is because the normal parasites in the hair follicles can cause immune disorders, increased immune complexes, decreased complement, increased -globulin, and fever, joint pain, bone lesions, etc. People think that AF patients are related to allergies.
Prevention
Burst acne prevention
Reasonable diet, eat more vegetables and fruits, eat less irritating foods such as fat, sugar and spicy, keep the stool smooth.
Complication
Burst acne complications Complications scleritis
A small number of patients have gangrenous pyoderma and scleritis.
Symptom
Fulminant acne symptoms Common symptoms Loss of appetite, eyebrows, depression, hepatosplenomegaly, papules, weight loss
Sudden onset, skin lesions mainly in the chest and back, can also appear in the face and neck, acne-like, multiple and clustered into pieces, visible follicular inflammatory papules, purulent sputum, severe inflammatory reaction, local pain, It is easy to form erosion, ulcers, and superficial scars.
The onset is often accompanied by fever, body temperature can be as high as 39 ° C or more, antibiotic treatment is not effective, there may be multiple arthritis, patients often have burnout, loss of appetite, muscle pain and headache and other systemic symptoms, a small number of patients have weight loss, osteomyelitis, liver Splenomegaly, anemia, nodular erythema, ankylosing spondylitis, Inflammatory disease, such as gangrenous pyoderma and scleritis.
Examine
Examination of fulminant acne
The total number of white blood cells in peripheral blood increased, the proportion of neutrophils increased (95%), erythrocyte sedimentation rate increased and C-reactive protein increased, anemia, microscopic hematuria, decreased complement, increased -globulin, increased muscle enzymes, immune complexes Increased and peripheral blood has myeloblasts, anterior myelocytes and myeloid cells.
Histopathology: Infiltration of neutrophils in and around the hair follicle wall of the hair follicle, part of the wall is destroyed, cells infiltrating with multinucleated cells and tissue cells can reach the fat layer, and epidermal necrosis can be seen in severe cases, and neutrality can be seen around the blood vessels. Infiltration of granulocytes and lymphocytes, partial formation of purulent sputum under the cornea, infiltration of inflammatory cells around the epidermis and sebaceous glands, and no vasculitis changes.
Diagnosis
Diagnosis and diagnosis of fulminant acne
According to the age of onset, there is a sudden spread of acne-like purulent sputum, distributed in the trunk and face, papules and purulent sputum are easy to form erosion, ulcers have superficial scars; systemic symptoms such as fever and joint pain, poor antibiotic efficacy, corticosteroids Treatment has significant efficacy, increased white blood cells and accelerated erythrocyte sedimentation rate can confirm the diagnosis of AF.
1. Polymeric acne (clustered acne) The disease also occurs in the trunk and face, but the age of onset is too large, the course of the disease is chronic and progressive, the lesions are mainly cysts and nodules, usually no symptoms and body Symptoms, antibiotic treatment is better than AF.
2. Acne-like acne (necrotic acne) Initially a brownish red hair follicle papule, after the central necrosis, leaving a acne-like scar, no tenderness at the skin lesions, without systemic symptoms.
