Dawn Eichenfield, MD: Tips for Managing Severe Acne


From addressing the rare acne fulminans to utilizing narrow-spectrum antibiotics, the modern field of acne treatment is more complicated than it seems.

About 1 in every 5 patients with acne vulgaris will develop a severe form of the disease, leading to heightened risk of painful symptoms and scarring. Especially in younger patients with severe acne, the disease can impact measures of quality of life and mental health as well.

Today’s armamentarium for advanced acne care is up to the task to treat the most severe cases—as long as prescribing clinicians know their strengths and limitations.

In an interview with HCPLive during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, Dawn Eichenfield, MD, a dermatologist with Rady’s Children Hospital – San Diego, discussed what many of her peers believe to be the most challenging form of severe acne: acne fulminans.

A rare disease by definition, acne fulminans is associated with ulcerating and hemorrhagic presentation of acne. Aside from the acutely painful symptoms, patients may experience systemic burdens including fever, bone lesions and polyarthritis. Even worse, it often takes a vital chess piece off the board for prescribing dermatologists.

“We see it a lot in the adolescent to older adolescent population, usually males that are 16-18 (years old),” Eichenfield said. “It’s usually refractory to isotretinoin or it becomes more inflamed with it.”

As such, Eichenfield recommended the use of steroids including prednisone, or even immunomodulatory agents including dapsone or a tumor necrosis factor (TNF) inhibitor to treat acne fulminans.

Eichenfield additionally discussed the importance of mitigating patient safety concerns over the potential use of antibiotics for their acne—and how emerging narrow-spectrum options address those concerns and the need for improved antibiotic stewardship.

“The acne guidelines now tell us we’re supposed to keep our oral antibiotics to about 3 months of use, and I completely agree with that,” Eichenfield said. “What’s great about the new oral antibiotic sarecycline is that it has a narrow spectrum; the idea is it would cause less harm or detriment to the bacteria in your gut.”

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