If acneiform bumps appear at places where acne is common, like the face, front of chest, back and buttocks, the possibility of the rare acne variants should always be considered.
Clinical Variants of Acne
Clinical types of acne are the different morphological types of the common acne, like the comedones, papules, pustules, nodules and cysts. In contrast, the clinical variants of acne include the rarer forms of acne with atypical characteristics and presentations as described below.
Acne Conglobata
Acne conglobata is a very severe acne variant where the nodules and cysts, because of the severe inflammation, break down to form interconnecting sinus tracts, deep abscesses and ulcers. Acne conglobata affects the back and chest more than the other variants of acne. Acne Conglobata, if not treated early, can cause extensive, permanent scarring.
Acne Fulminans
This rare form of acne is usually seen in teenage boys and has a sudden onset with severe inflammatory boils erupting and leaving deep ulcers and erosions. Acne fulminans is often accompanied by fever and joint and body pains.The primary lesions in acne fulminans are painful pustules and deep abscesses.
Acne Excoriée
Acne excoriee is primarily considered a dysmorphophobia where young women (usually), because of psychological and emotional upsets, cause excoriations and deep marks due to incessant scratching at real or imagined acne bumps.
Acne Mechanica
Acne mechanica is a variant of acne which is caused by continuous pressure or rubbing. These may be caused by a tight fitting cloth, mask or hat. A heavy helmet can cause acne mechanica on the forehead, scalp or nape of the neck. The primary lesions are papules.
Acne Cosmetica
Oily make up foundations can cause acneiform eruptions in predisposed individuals. These products are known as comedogenic and the acne like papular eruptions are known as acne cosmetica.
Chloracne
A common skin disease in industrial workers, chloracne is an occupational acne characterized by large open comedones or blackheads, especially in areas like forearm and back of hands. Chloracne is caused by the occupational exposure to chlorinated hydrocarbons in electrical conductors, insecticides, herbicides and industrial dioxin.
Hemorrhagic Acne
This acne variant is caused by inflammatory acne lesions which are painful and bleeding. This is a very distressing acne variant for the sufferer.
Neonatal and Infantile Acne
Acneiform eruptions are common in newborn babies and could be caused by the irritation caused by birth canal secretions during delivery (in neonates) or due to the action of maternal androgens circulating in the blood stream in the infants. Occluding oil baths are also one cause of neonatal acne. The skin colored or red papular eruptions are more common on the cheeks and nose.
Keloidal Acne
In individuals with a keloidal tendency, acne tends to heal with keloids, a thick uncontrolled growth of scar tissue.
Tropical Acne
Acne tropicalis is common in tropical climates and is characterized by skin colored and infected acne bumps, inflamed nodules and draining cysts on the trunk and buttocks.
Pyoderma Faciale
Primarily affecting females, pyoderma faciale presents with sudden eruption of large, tender, red cystic swelling, on the central portion of the cheeks. This acne variant requires immediate medical treatment, sometimes even surgical drainage so as to avoid disfiguring deep acne scars.
Acne Medicamentosa
Acne medicamentosa is acneiform eruptions induced by systemic or topical medications. Steroid acne is quite common following ingested and topically applied fluorinated steroids.
Acne Venenata
This is acne caused by contact sensitivity to chemical agents like cosmetics (acne cosmetica), oils, creams etc.
Pomade Acne
Pomade acne is seen on the forehead and nape of neck from pomades or gels applied to the hair, especially in persons of African origin.
Favre-Racouchot Disease
Comedones and cysts, appear on chronic sun damaged and aging skin, especially around the eyes and nose, along with other signs like dryness, skin thickening and solar elastosis.
Recognizing acne variants is important as most of these types of acne have some other initiating causes. The treatment of an acne variant includes that of the specific cause followed by treatment according to the clinical types of the acne.
Related Articles
References
- Simpson NB & Cunliffe WJ. Disorders of the Sebaceous Glands in Rook’s Textbook of Dermatology. 2004; 7: 43.1-43.75.
- Disorders of Sebaceous and Apocrine Glands in Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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