When acne is not vulgar | Pediatric Oncall Journal

CASE REPORTS

When acne is not vulgar

Sofia Poço Miranda, Inês Eiras, Cátia Juliana Silva, André Costa e Silva, Inês Correia Magalhães, Hugo Rodrigues.

Pediatrics Department, Unidade Local de Saúde do Alto Minho, Santa Luzia Hospital, Viana do Castelo, Portugal.

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Abstract
A previously healthy 15-year-old male adolescent was evaluated in a Dermatology consultation for inflammatory lesions, with pustules and inflammatory nodules, affecting the trunk and face, compatible with severe acne, for one year, having started treatment with oral isotretinoin. After the beginning of treatment, the lesions worsened, with the appearance of painful exuberant inflammatory lesions with purulent and bloody exudate and erosive areas, associated with myalgias of the lower limbs. Treatment was discontinued and oral prednisolone was started. After starting corticosteroids, he showed clear clinical improvement, with fewer inflammatory and exudative lesions. After 40 days of treatment, while continuing treatment with prednisolone, he presented a marked improvement in acne, so he started oral isotretinoin, with a sustained improvement in his acne, with scarring predominating and no inflammatory lesions.

Why this article important?

With this clinical case, the authors want to emphasize the importance of recognizing this often-underdiagnosed clinical entity. Acne vulgaris, although extremely prevalent in adolescence, may occur in severe forms with the potential for systemic involvement. Therefore, all pediatricians and primary care physicians should take this diagnosis into account

Summary of article

This case draws our attention to a previously healthy 15-year-old male adolescent with acne vulgaris for one year with the appearance of painful exuberant inflammatory lesions with purulent and bloody exudate and erosive areas, associated with myalgias of the lower limbs, without history of fever, osteoarticular pain, or other complaints. The patient was referred to a new Dermatology consultation 2 months later and oral minocycline and topical mupirocin were added to the treatment. On objective examination, he was apyretic and hemodynamically stable, with a good general state with ruddy and hydrated skin and mucous membranes, with painful eruptions of inflammatory nodules, ulcers, and crusts with purulent and bloody exudate, as well as extensive erosive areas, mainly on the back, pre-sternal region and face. Acne fulminans diagnosis was assumed and treatment with isotretinoin and minocycline was discontinued and oral prednisolone was started. After starting corticosteroids, he showed clear clinical improvement, with fewer inflammatory and exudative lesions.

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