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

Editor: Dirk M Elston, MD more... Updated: Feb 08, 2016 History Patients with
acneiform eruptions present with acnelike lesions such as papulonodules,
pustules, and cysts. They typically do not present with comedones, which is a
distinguishing factor. The physical location may be outside of the area in which
acne vulgaris occurs. Acneiform eruptions can be distinguished from acne
vulgaris by a history of sudden onset, monotonous lesion morphology, and
development of the eruption at an age outside the range typical of acne vulgaris.
In the case of druginduced acneiform eruptions, the eruption resolves with
discontinuation of the medication. Physical Nevus comedonicus (NC) is an
infrequent developmental anomaly manifesting as aggregated open comedones.
It consists of dilated follicular or eccrine orifices plugged with keratin. Also known
as comedone nevus and nevus acneiformis unilateralis, it may be solitary,
congenital, or, less frequently, can occur later in life as a result of occupational
exposure. The differential diagnosis of NC includes familial dyskeratotic
comedones and linear comedone formations usually linked with acne vulgaris or
chronically sundamaged skin (FavreRacouchot disease). Infrequently, multiple
comedones in other unusual contexts may raise NC as a possible consideration.
Treatment of NC is generally surgical, through excision or carbon dioxide laser
ablation of the involved skin. Medical therapy with topical retinoids may be of
some benefit. For more information, see Nevus Comedonicus. The eruptive vellus
hair cysts [6] manifest as fleshcolored papules found usually on the face, chest,
neck, thighs, groin, buttocks, and axillae. They represent an anomaly of the
vellus hair follicles and may be hereditary. Histopathology reveals a mid dermal
epithelial cyst containing vellus hairs and keratinous material. These cysts may
undergo spontaneous regression, form a connection to the epidermis, or undergo
degradation with a resultant foreign body granulomatous formation. Treatment is
often difficult. Incision and drainage of individual lesions carries the risk of
subsequent scarring, and modalities such as carbon dioxide laser ablation are
difficult to use over large surface areas. Topical retinoids and 12% lactic acid
preparations have proven useful in some instances. For more information, see
Eruptive Vellus Hair Cysts. Steroid acne [7, 8] is observed as monomorphous
papulopustules located predominantly on the trunk and extremities, with less
involvement of the face. Characteristically, it appears after the administration of
systemic corticosteroids, including intravenous therapy. Topical or inhaled
corticosteroids may cause an acneiform eruption of the area of skin under which
the topical preparation is applied or in around the nose or mouth in the case of
inhaled steroids. The eruption usually resolves after discontinuation of the
steroid and, in addition, may respond to the usual treatments of acne vulgaris.
For more information, see Acne Vulgaris. Exposure to halogenated aromatic
hydrocarbon compounds, such as chlorinated dioxins and dibenzofurans, by
inhalation, ingestion, or direct contact of contaminated compounds or foods
induces a cutaneous eruption of polymorphous comedones and cysts referred to
as chloracne. Other associated skin findings may include xerosis and pigmentary
changes. Internal changes involving the ophthalmic, nervous, and hepatic
systems may also occur, and some chloracnegens can be oncogenic. Treatment
is difficult because chloracne may persist for years, even without further
exposure. Chemicals that contain iodides, bromides, and other halogens can also
induce an acneiform eruption similar to that of steroid acne however, the iodideinduced eruption may be more extreme. Antibiotics may induce an acute

generalized pustular eruption. Penicillins and macrolides are the greatest

offenders. Patients usually are febrile with leukocytosis, and the eruption does
not usually involve comedones. Other implicated antibiotics include cotrimoxazole, doxycycline, ofloxacin, and chloramphenicol. Other types of
medications can also produce an acnelike eruption, including corticotropin,
nystatin, isoniazid, itraconazole, hydroxychloroquine, naproxen, mercury,
amineptine, [9, 10, 11] the antipsychotics olanzapine and lithium, chemotherapy
drugs, and epidermal growth factor receptor inhibitors. [12, 13, 14, 15, 16, 17,
18, 19] For more information, see Drug Eruptions. Various infections may also
display an acneiform pattern. Gramnegative folliculitis, a persistent
papulopustular eruption, may be a complication in patients on prolonged
treatment with oral antibiotics for acne vulgaris or rosacea. Antibiotic use, such
as those of the tetracycline class, can alter the normal skin flora of the skin
allowing for growth of gramnegative organisms in the nares of the nose. These
gramnegative organisms are typically spread to the skin of the upper lip, chin,
and jawline whether they cause a folliculitis. Culture of the papulopustules grows
gramnegative bacilli and gramnegative rods, including Escherichia coli and
Klebsiella, Enterobacter, and Proteus species. Typical history is a patient with a
sudden acne flare despite no change in treatment or a patient unresponsive to
traditional therapies. Oral isotretinoin is considered standard of care. For more
information, see GramNegative Folliculitis, Acne Vulgaris, and/or Rosacea.
Pityrosporum folliculitis is another infectious folliculitis that is presumably caused
by a host reaction to the yeast Malassezia furfur, previously named Pityrosporum