Crusted lesions of the upper chest and back in a tall thin boy are typical of acne fulminans.

ACNE FULMINANS

Acne fulminans (AF) is the explosive flare of crusted, inflammatory acne lesions in a patient with acne.

AF usually affects the young, tall male on the chest and back.
Patients often experience fever, myalgias, and arthralgias.
Occasionally, malaise, hepatosplenomegaly, leukocytosis, and an elevated ESR are associated.
AF may be precipitated by isotretinoin.

The patient experiences the explosive onset of inflammatory nodules, crust, and ulcerative lesions on the upper trunk, especially the midchest and shoulders. There is often a history of mild acne. The most commonly affected patients are tall, white teenage boys. AF may be precipitated by isotretinoin therapy, testosterone therapy, or it may develop without any obvious trigger factors. Pyogenic granuloma lesions may form in the crusts. Erythema nodosum may occur concurrently.

Funny sparing of the upper chest/neck.

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