TY - JOUR

T1 - Tumor necrosis factor-α inhibitor treatment of acne fulminans – a clinical and literature review

AU - Taudorf, Elisabeth Hjardem

AU - Jensen, Mikkel Bak

AU - Bouazzi, Dorra

AU - Sand, Carsten

AU - Thomsen, Simon Francis

AU - Jemec, Gregor Borut Ernst

AU - Saunte, Ditte Marie Lindhardt

N1 - Publisher Copyright: © 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by Wiley-VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.

PY - 2024

Y1 - 2024

N2 - Acne fulminans (AF) is a rare, serious, sudden-onset and long-lasting skin disease that causes scarring of face and body. Standard treatment with combined long-term isotretinoin and prednisolone is not always sufficient and has a well-known propensity for adverse effects leaving an unmet need for improved therapy. Case reports suggest that tumor necrosis factor (TNF)-α inhibitors may play a role in the management of AF. In a 3-year retrospective data collection from two dermatology centers and literature review of clinical cases of acne fulminans treated with anti-TNF-α therapy, three clinical cases and twelve literature cases were identified. A total of five different TNF-α inhibitors have been tested, with adalimumab being the most commonly used. Clinical response was seen after 1 month in 2/3 (67%) clinical cases and 5/12 (42%) literature cases, respectively, and treatment was successful in 2/3 (67%) and 11/12 (92%) after a median 3–7 months. All reported adverse effects were mild and reversible. Anti-TNF-α treatment may provide rapid improvement in patients with AF when initial treatment with isotretinoin and prednisolone fails. However, randomized controlled trials are lacking, and exact dosage and timing need to be explored before clinical implementation.

AB - Acne fulminans (AF) is a rare, serious, sudden-onset and long-lasting skin disease that causes scarring of face and body. Standard treatment with combined long-term isotretinoin and prednisolone is not always sufficient and has a well-known propensity for adverse effects leaving an unmet need for improved therapy. Case reports suggest that tumor necrosis factor (TNF)-α inhibitors may play a role in the management of AF. In a 3-year retrospective data collection from two dermatology centers and literature review of clinical cases of acne fulminans treated with anti-TNF-α therapy, three clinical cases and twelve literature cases were identified. A total of five different TNF-α inhibitors have been tested, with adalimumab being the most commonly used. Clinical response was seen after 1 month in 2/3 (67%) clinical cases and 5/12 (42%) literature cases, respectively, and treatment was successful in 2/3 (67%) and 11/12 (92%) after a median 3–7 months. All reported adverse effects were mild and reversible. Anti-TNF-α treatment may provide rapid improvement in patients with AF when initial treatment with isotretinoin and prednisolone fails. However, randomized controlled trials are lacking, and exact dosage and timing need to be explored before clinical implementation.

KW - Acne fulminans

KW - adalimumab

KW - anti-TNF-α therapy

KW - tumor necrosis factor-α inhibitors

U2 - 10.1111/ddg.15234

DO - 10.1111/ddg.15234

M3 - Journal article

C2 - 38128111

AN - SCOPUS:85180212117

VL - 22

SP - 23

EP - 27

JO - JDDG - Journal of the German Society of Dermatology

JF - JDDG - Journal of the German Society of Dermatology

SN - 1610-0379

IS - 1

ER -