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Acneiform Eruptions Clinical Presentation Author: Julianne H Kuik, MD Chief

Editor: Dirk M Elston, MD more !pdated: "e# $%, &$'( Histor) Patients *ith

acneiform eruptions present *ith acnelike lesions such as papulonodules,

pustules, and c)sts +he) t)picall) do not present *ith comedones, *hich is a

distinuishin factor +he ph)sical location ma) #e outside of the area in *hich

acne -ularis occurs Acneiform eruptions can #e distinuished from acne-ularis #) a histor) of sudden onset, monotonous lesion morpholo), and

de-elopment of the eruption at an ae outside the rane t)pical of acne -ularis

.n the case of druinduced acneiform eruptions, the eruption resol-es *ith

discontinuation of the medication Ph)sical /e-us comedonicus 0/C1 is an

infre2uent de-elopmental anomal) manifestin as areated open comedones

.t consists of dilated follicular or eccrine ori3ces plued *ith keratin Also kno*n

as comedone ne-us and ne-us acneiformis unilateralis, it ma) #e solitar),

conenital, or, less fre2uentl), can occur later in life as a result of occupational

e4posure +he di5erential dianosis of /C includes familial d)skeratotic

comedones and linear comedone formations usuall) linked *ith acne -ularis or

chronicall) sundamaed skin 0"a-re6acouchot disease1 .nfre2uentl), multiplecomedones in other unusual conte4ts ma) raise /C as a possi#le consideration

+reatment of /C is enerall) surical, throuh e4cision or car#on dio4ide laser

a#lation of the in-ol-ed skin Medical therap) *ith topical retinoids ma) #e of

some #ene3t "or more information, see /e-us Comedonicus +he erupti-e -ellus

hair c)sts 7(8 manifest as eshcolored papules found usuall) on the face, chest,

neck, thihs, roin, #uttocks, and a4illae +he) represent an anomal) of the

-ellus hair follicles and ma) #e hereditar) Histopatholo) re-eals a mid dermal

epithelial c)st containin -ellus hairs and keratinous material +hese c)sts ma)

undero spontaneous reression, form a connection to the epidermis, or undero

deradation *ith a resultant forein #od) ranulomatous formation +reatment is

often di9cult .ncision and drainae of indi-idual lesions carries the risk of

su#se2uent scarrin, and modalities such as car#on dio4ide laser a#lation are

di9cult to use o-er lare surface areas +opical retinoids and '& lactic acid

preparations ha-e pro-en useful in some instances "or more information, see

Erupti-e ;ellus Hair C)sts

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enerali>ed pustular eruption Penicillins and macrolides are the reatest

o5enders Patients usuall) are fe#rile *ith leukoc)tosis, and the eruption does

not usuall) in-ol-e comedones ?ther implicated anti#iotics include co@

trimo4a>ole, do4)c)cline, oo4acin, and chloramphenicol ?ther t)pes of

medications can also produce an acnelike eruption, includin corticotropin,

n)statin, isonia>id, itracona>ole, h)dro4)chloro2uine, napro4en, mercur),amineptine, 7, '$, ''8 the antips)chotics olan>apine and lithium, chemotherap)

drus, and epidermal ro*th factor receptor inhi#itors 7'&, 'B, ', ', '(, '=,

'%, '8 "or more information, see Dru Eruptions ;arious infections ma) also

displa) an acneiform pattern ramneati-e folliculitis, a persistent

papulopustular eruption, ma) #e a complication in patients on proloned

treatment *ith oral anti#iotics for acne -ularis or rosacea Anti#iotic use, such

as those of the tetrac)cline class, can alter the normal skin ora of the skin

allo*in for ro*th of ramneati-e oranisms in the nares of the nose +hese

ramneati-e oranisms are t)picall) spread to the skin of the upper lip, chin,

and Fa*line *hether the) cause a folliculitis Culture of the papulopustules ro*s

ramneati-e #acilli and ramneati-e rods, includin Escherichia coli andKle#siella, Entero#acter, and Proteus species +)pical histor) is a patient *ith a

sudden acne are despite no chane in treatment or a patient unresponsi-e to

traditional therapies ?ral isotretinoin is considered standard of care "or more

information, see ram/eati-e "olliculitis, Acne ;ularis, andGor 6osacea

Pit)rosporum folliculitis is another infectious folliculitis that is presuma#l) caused

#) a host reaction to the )east Malasse>ia furfur, pre-iousl) named Pit)rosporum