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Acne fulminans and methaemoglobinaemia: case report An 18-year-old man developed acne fulminans during treatment with isotretinoin for nodulocystic acne, and methaemoglobinaemia during treatment with dapsone, which was erroneously administered at a high dose for acne fulminans. The man presented with an abrupt flare of inflammatory acne on his chest and back, along with erosions and haemorrhagic nodules He had nodulocystic acne on his back, and he had been receiving isotretinoin 30mg daily [route not stated] for the past 11 months. At the current presentation, he was diagnosed with acne fulminans. Upon anamnesis, he denied use of testosterone or any anabolic steroid. Based on the clinical presentation, it was determined that isotretinoin was the only triggering factor for the acne fulminans. A diagnosis of isotretinoin-induced acne fulminans without systemic symptoms (IIAF-WOSS) was thus considered. The dose of isotretinoin was therefore reduced to 10mg daily, and the man started receiving oral corticosteroid therapy with prednisone 20mg daily (0.5 mg/kg/day) concomitantly. However, the therapy was found to be unsuccessful after 3 months of treatment. Isotretinoin was then discontinued, and he started receiving oral dapsone 100mg daily. Subsequently, oral corticosteroids were decreased gradually and then stopped 1 month later. Less than 2 months after initiating treatment with dapsone, he experienced tiredness and shortness of breath. Also, met-haemoglobin level was found to be too high (methaemoglobinaemia). It was later determined that, the methaemoglobinaemia might have caused due to the wrong dose adjustment of dapsone in accordance with his low weight (100 mg/day was erroneously being administered instead of 50 mg/day as per his body weight of approximate 50kg). Dapsone was therefore stopped. After rapid normalisation of both methaemoglobinaemia and associated clinical symptoms, the man again started receiving oral dapsone, but at a reduced dose of 50mg daily. Subsequently, he achieved a complete remission after 8 months. No relapse was observed thereafter. Legal K, et al. Isotretinoin-induced acne fulminans without systemic symptoms treated successfully with oral dapsone. Acta Dermato-Venereologica 100: 1-2, No. 1, 23 Jan 803497813 2020. Available from: URL: http://doi.org/10.2340/00015555-3354

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Reactions 22 Aug 2020 No. 1818