BONE-DISEASE IN ADOLESCENTS WITH ACNE FULMINANS AND SEVERE CYSTIC ACNE - RADIOLOGIC AND SCINTIGRAPHIC FINDINGS

OBJECTIVE. Acne fulminans is an uncommon form of ulcerative acne with acute onset. It usually affects adolescent boys who have associated mu sculoskeletal pain and septic fever. Osteolytic bone lesions have been reported in these patients. Severe cystic acne occurs almost equally in both sexes, but it has a less dramatic clinical course than acne fu lminans and rarely causes ulcerative skin lesions and systemic symptom s. In this study we investigated the imaging features of bone lesions associated with acne fulminans and determined if patients with severe cystic acne have similar bone lesions. SUBJECTS AND METHODS. From 1970 through 1991, 24 patients with acne fulminans were treated in the der matologic departments of Finnish hospitals. Radiologic (plain radiogra phs or conventional tomograms) or scintigraphic data were available fo r 21 patients and analyzed retrospectively. For comparison, 20 consecu tive patients with severe cystic acne were examined prospectively with scintigraphy. RESULTS. Ten patients (48%) with acne fulminans had lyt ic bone lesions on the radiographs, and the bone scans showed increase d uptake in 14 patients (67%). Destructive lesions resembling osteomye litis were seen in seven patients. The bones of the anterior chest wal l were predominantly involved: sternum in four patients, clavicle in t hree patients, and acromion scapulae in one patient. Sternoclavicular hyperostosis was seen in six patients. Four patients had small lytic l esions in the epiphyseal growth plate or a periosteal reaction. Follow -up was performed in eight patients with acne fulminans and in seven r evealed either normal findings or sclerosis and hyperostosis in the pr eviously affected areas of the sternum and clavicles. Slightly increas ed uptake of radionuclide, usually in the sternum or around the sterno clavicular joints, was seen in nine patients with severe cystic acne, but these findings were regarded as normal and radiographs were not ob tained. CONCLUSION. Lytic lesions in the bones of the anterior chest w all and in the epiphyseal growth plates are common in patients with ac ne fulminans, but do not seem to occur in patients with severe cystic acne. The prognosis of bone disease associated with acne fulminans app ears to be good, and the chronic sequelae, if any, are mild sclerosis and hyperostosis of the affected bones. Acne fulminans should be added to the list of dermatoses associated with bone lesions detectable by radiologic and scintigraphic methods.