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Acneiform Eruptions

What Are Acneiform Eruptions?

Acneiform eruptions are skin lesions that are similar to those acne vulgaris.

What Causes Acneiform Eruptions?

Causes of acneiform eruptions include:

1. Medications

Steroid acne is a type of acneiform eruption which develops in patients taking corticosteroids. Lesions which are monomorphic (uniform appearance) and dome-shaped develop on the chest, limb and face in patients taking the steroids by mouth or intravenously (in the vein). Patients applying the steroids on their skin can develop the acneiform lesions on those areas. Patients inhaling steroids can also develop the acneiform eruptions around their nose or mouth.

Penicillins usually cause an acute generalized pustular eruption which does not have comedones. It is mainly located in the trunk and limbs.

Epidermal growth factor (EGF) receptor inhibitors which are used to treat cancer like cetuximab (Erbitux) and erlotinib can also cause acneiform eruptions.

2. Chemicals

Chloracne is characterized by polymorphous cysts which may be associated with xerosis (dry skin) and color changes. It develops in persons exposed to chlorinated dioxins and dibenzofurans either by inhalation or ingestion or direct contact.

3. Infections

Gram negative folliculitis is a papulopustular (small pimples with pus) eruption which is caused by Gram negative bacteria like Escherichia coli, Serratia marescens and the Proteus species. It can develop on the chin as a result of using antibiotics like the tetracyclines for a long time to treat acne vulgaris.

Pityrosporum folliculitis is a pruritic (itchy) eruption which is caused by a reaction to the yeast Malassezia furfur (Pityrosporum ovale). It can develop on the trunk and upper limbs of young adults.

Eosinophilic pustular folliculitis (EPF) is a pruritic, papulopustular eruption which presumed to be a type of allergic hypersensitivity. It can develop on the face, trunk and limbs. It exists as three forms namely (i) infantile form (ii) HIV associated form which is treated with antihistamines like cyproheptadine and hydroxyzine (iii) classic Ofuji disease which affects mainly immunocompetent Japanese and is treated with by taking indomethacin by mouth.

Secondary syphilis is caused by Treponema pallidum and can present with papulopustules and nodules on the face, trunk and limbs.

4. Cutaneous Conditions

Rosacea is associated with facial papulopustules, telangiectasia and flushing. Comedones are not present. There may also be eye symptoms like redness, tearing, dryness, a sensation of foreign bodies in the eyes and photophobia. It can be triggered by the sun, wind, weather extremes, drinking alcohol, eating hot and spicy foods. It follows a course characterized by exacerbations and remissions.

Perioral dermatitis typically presents with papulopustules on an erythematous (red) base. These discrete pinpoint lesions mainly affect the perioral region (around the mouth) but spare the vermilion border of the lip. It mainly affects young women and is thought to be caused by using fluorinated topical corticosteroids.

5. Genetic Disorders

Tuberous sclerosis, which is also known as adenoma sebaceum or tuberous sclerosis complex (TSC), is a genetic disorder that affects the skin, brain, spinal cord, heart and kidneys. Most cases of tuberous sclerosis are caused by mutations or changes in the TSC1 and TSC2 genes. Skin involvement is characterized angiofibromas, formerly known as adenoma sebaceum, which are hese red swellings on the cheeks on the cheeks, nose and forehead. They are treated by vaporization with lasers. Medications are also prescribed to control the convulsions. Surgery is used to remove some of the tumors which may be causing the convulsions and also those in the kidneys. Special education is given to the children with different degrees of developmental delay and mental retardation.

6. Other Disorders

Comedone nevus, which is also known as comedo naevus or acneiformis unilateralis, is actually a misnomer since there are actually no comedones. It is characterized by grouped, dilated hair follicle openings or eccrine sweat gland orifices which are filled with keratin. It can be congenital or present at birth or it can be acquired due to occupational exposure. These lesions which can develop on any part of the body are commonly found on the face and trunk. Treatment is by vaporization with a carbon dioxide laser or excision surgically. Topical tretinoin has also been used for treatment.

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What Are The Symptoms Of Acneiform Eruptions?

Symptoms of acneiform eruptions include:

1. Skin lesions that resemble those of acne vulgaris

They can be papulopustular (small swellings with pus), nodules (larger swellings) and cysts (fluid filled swellings).

 

2. The absence of comedones

Black head and white heads and not present.

 

3. Monomorphic appearance

Acneiform lesions have a uniform appearance.

 

4. Unusual location

Acneiform lesions can affect areas that are not typically affected by acne vulgaris. These non-seborrheic areas can include the limbs.

 

5. Unusual age of onset

Acneiform lesion tend to begin in age groups not typically associated with acne vulgaris depending on their specific causes.

 

6. Sudden onset

Acneiform lesions usually begin suddenly. This is in contrast to acne vulgaris which is usually a chronic condition that persists for months to years.

 

7. Resolution once the cause is treated.

For example acneiform lesions caused by medications resolve once the medication is discontinued.

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What Tests Are Done For Acneiform Eruptions?

Investigations for patients with acneiform eruptions can include:

1. Skin biopsy

This is not typically done but when done, the affected area is numbed with local anesthesia and a small piece of the skin is removed and taken to be examined under the microscope in the laboratory.

2. Drug withdrawals

Suspected causative drugs can be withdrawn

3. Other tests like cultures and serologic tests are also done depending on the suspected cause.

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What Is The Treatment For Acneiform Eruptions?

The treatment for acneiform eruptions includes:

1. Withdrawing offending drugs

2. Treat the underlying cause

3. Medications

Medications like tetracycline and erythromycin are often prescribed to treat drug related acneiform eruptions after the offending drug has been withdrawn.

Self Help For Acneiform Eruptions

The fact that it looks like acne, does not mean that it is acne. Let your doctor examine you and ascertain whether or not it is acne vulgaris before you begin using over the counter acne medications.

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