OSCE — Acne fulminans

Brief (to candidate)

You will assess a patient with a presentation consistent with Acne fulminans.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Acne fulminans is the most severe form of acne, characterised by sudden onset of large, painful, ulcerative nodules with necrotic haemorrhagic crusts on the chest, back and face, accompanied by systemic symptoms (fever, arthralgia, myalgia) and laboratory abnormalities (leukocytosis, elevated ESR/CRP). It primarily affects adolescent males. The pathophysiology is a Type III hypersensitivity / immune-complex reaction to Cutibacterium acnes. Treatment is a dermatological emergency: systemic corticosteroids FIRST with isotretinoin added at low dose only after the inflammatory phase settles and with steroid overlap — isotretinoin alone can worsen the condition, so follow local dermatology protocol for exact doses and durations.^[2][3]

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[2]