Laasonen L S, Karvonen S L, Reunala T L
Department of Radiology, University Central Hospital of Helsinki, Finland.
AJR Am J Roentgenol. 1994 May;162(5):1161-5. doi: 10.2214/ajr.162.5.8166004.
Acne fulminans is an uncommon form of ulcerative acne with acute onset. It usually affects adolescent boys who have associated musculoskeletal 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 fulminans and rarely causes ulcerative skin lesions and systemic symptoms. 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.
From 1970 through 1991, 24 patients with acne fulminans were treated in the dermatologic departments of Finnish hospitals. Radiologic (plain radiographs or conventional tomograms) or scintigraphic data were available for 21 patients and analyzed retrospectively. For comparison, 20 consecutive patients with severe cystic acne were examined prospectively with scintigraphy.
Ten patients (48%) with acne fulminans had lytic bone lesions on the radiographs, and the bone scans showed increased uptake in 14 patients (67%). Destructive lesions resembling osteomyelitis were seen in seven patients. The bones of the anterior chest wall were predominantly involved: sternum in four patients, clavicle in three patients, and acromion scapulae in one patient. Sternoclavicular hyperostosis was seen in six patients. Four patients had small lytic lesions in the epiphyseal growth plate or a periosteal reaction. Follow-up was performed in eight patients with acne fulminans and in seven revealed either normal findings or sclerosis and hyperostosis in the previously affected areas of the sternum and clavicles. Slightly increased uptake of radionuclide, usually in the sternum or around the sternoclavicular joints, was seen in nine patients with severe cystic acne, but these findings were regarded as normal and radiographs were not obtained.
Lytic lesions in the bones of the anterior chest wall and in the epiphyseal growth plates are common in patients with acne fulminans, but do not seem to occur in patients with severe cystic acne. The prognosis of bone disease associated with acne fulminans appears 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.
暴发性痤疮是溃疡性痤疮的一种罕见的急性发作形式。它通常影响伴有肌肉骨骼疼痛和败血症热的青春期男性。这些患者中曾有溶骨性骨病变的报道。严重囊性痤疮在男女中发病几率几乎相同，但与暴发性痤疮相比，其临床病程不那么严重，很少引起溃疡性皮肤病变和全身症状。在本研究中，我们调查了与暴发性痤疮相关的骨病变的影像学特征，并确定重度囊性痤疮患者是否有类似的骨病变。
1970年至1991年期间，芬兰医院皮肤科共治疗了24例暴发性痤疮患者。21例患者有放射学（平片或传统体层摄影）或闪烁扫描数据，并进行回顾性分析。为作比较，对20例连续的重度囊性痤疮患者进行了前瞻性闪烁扫描检查。
10例（48%）暴发性痤疮患者的X线片上有溶骨性骨病变，14例（67%）患者的骨扫描显示摄取增加。7例患者可见类似骨髓炎的破坏性病变。前胸壁骨骼受累为主：4例患者胸骨受累，3例患者锁骨受累，1例患者肩胛肩峰受累。6例患者可见胸锁关节骨质增生。4例患者在骨骺生长板有小的溶骨性病变或骨膜反应。对8例暴发性痤疮患者进行了随访，7例患者显示胸骨和锁骨先前受累区域正常或有硬化及骨质增生。9例重度囊性痤疮患者可见放射性核素摄取略有增加，通常在胸骨或胸锁关节周围，但这些表现被视为正常，未获取X线片。
前胸壁骨骼和骨骺生长板的溶骨性病变在暴发性痤疮患者中很常见，但在重度囊性痤疮患者中似乎不会出现。与暴发性痤疮相关的骨病预后似乎良好，如有慢性后遗症，也只是受累骨骼的轻度硬化和骨质增生。暴发性痤疮应列入可通过放射学和闪烁扫描方法检测到骨病变的皮肤病名单中。
