An acute febrile reaction in acne conglobata was first described  in  1958 by Burns and Colville18 and many similar cases  have been reported. Kelly and Burns introduced the apposite name for this syndrome: 'acute, febrile,  ulcerative conglobata  acne with  polyarthralgia'. The main features are:

1. The sudden onset.
2. Severe and, at times, often ulcerating acne.
3. Toxic effects as  demonstrated by fever and  poly  arthralgia.
4. Failure  to respond to antibacterial therapy.  

Favourable response to debridement in combination  with steroid therapy. Males are  much more frequently affected than females. Severe truncal acne is a common feature . The inflamed lesions often ulcerate and healing lesions show  considerable granulation tissue.  The inflammatory arthralgia may affect one or several joints, especially the  hips, knees and thighs. The patient is usually unwell and has often been admitted to an orthopaedic or general medical ward.

  Multifocal  osteolytic cysts  have  been  described uncommonly.  These  lesions, which may present as tender bones, can be detected as 'hot spots'  by technetium scintillography. Biopsy of the bony lesions  shows  reactive changes only.  An association  with Crohn's disease has been  reported in one patient. Patients with erythema nodosum have also been documented; in two patients the erythema nodosum lesions developed during  isotretinoin therapy.  An elevated white blood count, with an increased percentage  of polymorphonuclear leucocytes,  is characteristic of this acute  disorder. The haematological reaction  may  be  very  pronounced:  in  one  case leukaemia seemed to be indicated. Blood cultures are usually sterile.

  Skin reactions in  acne  fulminans have  been infrequently monitored.  Palatsi  investigated five  patients with acne fulminans, who reacted negatively to recall antigens   and  to   twenty-five   common   contact allergens. Dinitrochlorobenzene (DNCB) did not induce sensitization in those four patients in whom it was carried out. However, the transformation of lymphocytes by phytohaemagglutinin (PHA) was normal. Five of seven  control patients with cystic or ordinary acne had positive  tuberculin test  reactions;  three of them were sensitized to DNCB.

  One acne fulminans patient who developed erythema nodosum showed severe necrotic reaction to P. acnes antigen at thirty-six hours, which  suggests that  acne fulminans is an Arthus' reaction to P. acnes.23 The need for oral steroids would support this view.