A 24-year-old woman with severe nodular acne on face and trunk was recently started on isotretinoin 0.5 mg/kg/day. At her 4-week visit she returns with a dramatic worsening — numerous inflamed nodules, cysts, and sinuses are forming with crusting. This phenomenon is known as:

• A Isotretinoin resistance
• B PAPA syndrome flare
• C Drug-induced rosacea
• D Acne fulminans — induced by isotretinoin ✓

Explanation

Acne fulminans is a severe, systemic form of acne characterised by abrupt onset of ulcerating nodules and plaques, systemic symptoms (fever, arthralgia, leukocytosis), and potential for scarring. It can be triggered by isotretinoin, particularly at initiation of therapy in patients with severe/extensive inflammatory acne. Management requires stopping isotretinoin temporarily, systemic corticosteroids (prednisolone 0.5–1 mg/kg/day) to control inflammation, and slow reintroduction of low-dose isotretinoin after resolution. Starting with lower isotretinoin doses and prednisolone cover prevents this complication.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.