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An acneiform eruption refers to the presence of one or more lesions resembling those seen in acne vulgaris such as comedones, inflammatory papules, pustules, nodules, and cysts. While acne vulgaris is the most common, the clinician should be aware of other inflammatory dermatoses presenting with acne-like lesions. These include rosacea, perioral dermatitis, folliculitis, acne agminata (Figures 1–37, 1–38, 1–39, 1–40, 1–41), Ofuji’s disease (Figures 1–50, 1–51, 1–52, 1–53) and hidradenitis suppurativa (Figures 1–54 and 1–55).

The initial clinical approach involves a thorough history, paying attention to the duration of illness, age of onset, aggravating factors, occupation, response to previous therapy, facial flushing, cosmetic, and medicament (especially topical corticosteroids) application. Important physical findings to note include the site of involvement (specific cosmetic units of the face, non-facial sites), presence or absence of comedones, background erythema, and telangiectasias. For atypical presentation or when a histology is essential for making the diagnosis (e.g., acne agminata, Ofuji’s disease), a biopsy may be indicated.

In Asians, common acneiform eruptions encountered include acne vulgaris, rosacea, perioral dermatitis, and folliculitis.


The commonest archetype acneiform eruption is acne vulgaris, a disease of the pilo-sebaceous unit (Figures 1–1, 1–2, 1–3, 1–4, 1–5, 1–6, 1–7, 1–8, 1–9, 1–10, 1–11, 1–12, 1–13, 1–14, 1–15, 1–16, 1–17, 1–18, 1–19, 1–20, 1–21). It affects up to 80% of adolescents, and it is estimated that up to 40% of adult women may be still plagued by this condition. The pathogenesis of acne is complex and multifactorial, with excessive sebum production, abnormal follicular keratinization, hormonal factors as well as Propionibacterium acnes or Cutibacterium acnes proliferation contributing to the various classical clinical features seen in acne.

Figure 1-1

Closed comedones

Acne vulgaris is the commonest skin disease in adolescents. It is characterized by non-inflammatory open or closed comedones and by inflammatory papules, pustules, and nodules. Closed comedones are also known as whiteheads. This young male aged 18 has multiple closed comedones on the forehead.

Figure 1-2

Closed comedones

Comedones are small, skin colored to whitish keratin-filled papules that result from follicular plugging. Often, the forehead is affected first, followed by the cheeks and later the chest and upper back. These non-inflamed lesions, which are first visible during the adrenarche (at around the ages of 9 to 11) in acne-prone individuals, do not contain Propionibacteria.

Figure 1-3

Closed comedones

This is another example of closed comedones located on the forehead of a young girl aged 10. Comedones may be treated with comedolytic agents such as topical retinoids (tretinoin, adapalene), ...

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