With reference to a new case of
acne conglobata-associated
rheumatic disease in a thirteen-year-old boy, we recall the characteristics of the main joint and/or bone manifestations that may occur during severe flares of
acne conglobata, but also
acne fulminans or pustulosis of the palms and soles. Joint manifestations mainly involve the large proximal joints of the limbs and consist in
pain rather than in signs of
inflammation. Although recurrences may develop,
joint disease responds to treatment of the
acne combined with a non-steroidal antiinflammatory
drug. Bone involvement consists in true rheumatic
osteitis with
hyperostosis responsible for densification and thickening of bone, mainly in the anterior chest wall and spine. The pathogenesis and nosologic place of these bone and joint manifestations remain controversial: they do not seem to represent true
reactive arthritis and, although the B27
antigen is usually lacking, they have been likened to the group of
spondylarthropathies, especially in those cases with sacroiliac involvement and
enthesopathy . Oddly enough, they are reminiscent of some of the side effects of
etretinate, an agent prescribed in these severe forms of
acne. After a national survey carried out in 1986, the acronym SAPHO (
Synovitis,
Acne, Pustulosis,
Hyperostosis,
Osteitis) was suggested to designate the range of skin, bone and joint manifestations observed.