Testosterone-induced acne fulminans in twins with Kallmann's syndrome

INTRODUCTION Acne fulminans is a rare and severe form of acne characterized by the development of painful and inflammatory nodules on the face, chest, and back. Systemic signs are associated with the onset, including fever, chills, and musculoskeletal pain. Erythema nodosum, liver or spleen enlargement, myositis, or aseptic bone involvement have been reported more rarely. Its etiology remains unknown. It is assumed that a strong activation of the cutaneous innate immunity induced by Propionibacterium acnes antigens could be involved. Another hypothesis is that it could be a dysregulation of some receptors expressed by sebaceous glands and keratinocytes, in particular, the androgen receptors. Moreover, these abnormalities could be genetically determined.