(1)
Department of Dermatology, University of Pennsylvania, Penn Presbyterian Medical Center Medical Arts Building, Philadelphia, PA, USA
8.1 Acne
8.2 Rosacea
8.3 Folliculitis
8.3.1 Superficial Folliculitis
8.3.2 Deep Folliculitis
8.3.3 Pseudofolliculitis
8.4 Follicular Cysts
Abstract
Acneiform disease includes conditions on the spectrum of acne and folliculitis as well as conditions that may resemble acne clinically, such as rosacea.
Keywords
AcneRosaceaAcneiform eruptions8.1 Acne
1.
Acne vulgaris
Common inflammatory skin disease, most often in puberty
Morphologies include comedonal, papular, pustular, nodulocystic
Pathophysiology related to:
1.
Increased sebum production
2.
Abnormal follicular epidermal turnover/keratinization
3.
Overgrowth of bacteria (gram positive diptheroid anaerobe Propionobacterium acnes)
4.
Inflammatory response (to foreign body)
Typical therapeutic ladder:
1.
Benzoyl peroxide in conjunction with topical antibiotic (clindamycin or erythromycin) and topical retinoid (for comedones)
2.
Systemic antibiotic (tetracyclines)
3.
Systemic retinoid (isotretinoin)
Androgenic hormones have significant influence on acne; with suspected strong hormonal component (e.g. acne flares monthly localizing more on jawline, chin), consider oral contraceptives and spironolactone
The role of diet in acne is controversial, but no strong evidence for diet connection
2.
Follicular occlusion tetrad
These four diseases are thought to be closely related and may co-exist; the primary pathophysiology involves occlusion and rupture of hair follicles with associated inflammation
This spectrum may be associated with inflammatory bowel disease, pyoderma gangrenosum, acne syndromes
(a)
Hidradenitis suppurativa
Aka “acne inversa”
Clinically may see sinus tracts and nodules, “double comedones”
Localizes typically to intertriginous areas (axillae, inguinal folds)
Previously, thought to be a primarily apocrine disease given the typically apocrine gland bearing affected areas, but now thought that apocrine glands are only secondarily inflamed and fibrosed
Associated with smoking, obesity
Treatments include intralesional steroids, topical and systemic antibiotics, isotretinoin (often not effective), anti-TNF biologics, surgery
(b)
Acne conglobata
Unusually severe nodulocystic acne with sinuses and scarring
(c)
Dissecting cellulitis
Aka perifolliculitis capitis abscedens et suffodiens
Clinically presents as cystic nodules on the scalp
May have overlap with folliculitis decalvans, which is more typically a flat and boggy scalp plaque
See also Alopecia:Scarring alopecia
(d)
Pilonidal sinus
Involves gluteal cleft
3.
Acne syndromes
(a)
Acne fulminans
Severe nodulocystic acne with variable systemic manifestations (fevers, arthralgias, hepatosplenomegaly), may have osteoclastic lesions, especially of the clavicle
(b)
SAPHO syndrome
Syndrome of synovitis, acne conglobata, pustulosis (often palmoplantar), hyperostosis, osteitis
Can be associated with Sweet’s
(c)
PAPA syndrome
Sterile pyogenic arthritis, pyoderma gangrenosum, and acne
Has been associated with pyrin/nod defects
(d)
PASH and PAPASH syndromes
Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) and pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hidradenitis (PAPASH)
4.
Other types of acne
(a)
Neonatal acne/neonatal cephalic pustulosis
No open or closed comedones seen
Onset usually first 2–3 weeks of life, resolves on own with no scarring within weeks, therapy not necessary
Associated with Malassezia sympodialis
(b)
Infantile acne
Usually begins at 3–6 months, may be associated with precocious secretion of gonadal androgens
Can persist; treated with topical retinoid/benzoyl peroxide
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