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TITLE CONTENT PAGES of NJDVL Vol 14 No 1 2016 CS4.Indd Resident's Corner Eponymous Names in Acne KC Shekhar1 1Resident, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal umerous terminologies have been linked to acne in the background of granulomatous histology, is Nand related lesions which o en puzzles students now considered to be a self resolving variant of and prac oners. Here we have tried to summarize granulomatous rosacea.5,6 It was previously also some of the common acne related terms found in known as facial papular tuberculid and lupoid related literatures. rosacea. 1. Acne aes valis / Mallorca Acne: Occupa ons involving hot and humid environment It is reported as a seasonal recurrent acneiform as cooks may develop acne as a result of excess erup on that starts in the spring, peaks in the hydra on and blockade of pilosebaceous duct. summer and resolves therea er.1 It was ini ally reported from the islands of Mallorca. No 3. Acne corne cause has been delineated but may result from Follicular horny pigmented papules involving the ultraviolet radia on. Dull red, dome shaped dorsa of hands, arms, legs, face or thorax which papules develop in the facial areas and upper may later disseminate to involve markedly around trunk mostly in post adolescent women. The the genitalia has been termed acne corne7. It is condi on responds well to topical re noids. thought to result from crude petroleum, tar oil or paraffi n products and closely resemble pityriasis 2. Acne agminata / Acni s / FIGURE (Facial rubra pilaris or lichen spinulosus. idiopathic granulomas with regressive evolu on) / Lupus miliaris disseminatus faciei /: 4. Acne conglobata The word “agminata” is derived from the La n It is a severe, chronic, infl ammatory variant of 2 word “agmen” meaning cluster. The disease is acne characterized by infl amed papules, tender named so because there are acne like papules nodules and abscesses which coalesce to form clustered around the eyes or mouth. draining sinuses involving the trunk.8 It commonly It is an uncommon but yet dis nct and chronic aff ects adult males in second to third decade with infl ammatory granulomatous dermatoses of minimal systemic upset. young adults.3,4 It is characterized by asymptoma c discrete, symmetrical, reddish brown to pink 5. Acne cosme ca monomorphic papulopustular erup on on the Among the various forms of induced acne, “muzzle” areas of face (cheeks, chin, eyebrows, cosme c acne refers to acne induced by eyelids and forehead).Involvement of body cosme cs.8 Comedone forma on occurs following parts including axilla, groin, genitals, scalp, the use of cosme cs containing comedogenic trunk and neck have been described. Histology ingredients which includes lanolin, petrolatum, reveals sca ered dermal granulomas composed butyl stearate, lauryl alcohol, oleic acid, of epitheloid and some giant cells with central vegetable oils. Dark skinned individuals are more casea on, which is evident as apple-jelly nodule aff ected as they are liable to use opaque and oil like appearance on diascopy. containing make-up for camoufl age of acne and Ini ally described as disseminated follicular lupus pigmenta on. Acne venenata is the term previously used for Address for correspondence acne induced by contact with exogenous agents. Shekhar KC Radia on acne follows irradia on of the skin Kathmandu University School of Medical Sciences following deeply penetra ng radia on. Dhulikhel, Kavre, Nepal E-mail: [email protected] 59 6. Acne cyst / Nodulocys c acne in violinists.15 Stump acne is a mechanical acne The term acne cyst is a misnomer as they are occurring over operated stumps and immobility not truly lined by an epithelium and are not acne in pressure zones due to prolonged bed true cysts.9 Pseudocysts or nodules are more rest.16 appropriate terminologies for these lesions. 12. Acne necro ca / Acne varioliformis / Acne 7. Acne detergicans frontalis / Necro zing lymphocy c folliculi s / Obsessive use of soaps, cleansers, scrubs and Acne necro ca miliaris : related products by pa ents with common It represents chronic relapsing papulo-pustular acne may aggravate the disease and result in its lesions in the area of the hairlines and on the extension to unusual loca ons and hence called scalp.17 Discrete excoriated follicular papules on acne detergicans.10 Soap and related products are the scalp demonstrate necro zing lymphocy c generally discouraged as they produce further folliculi s.18 Early lesions are non-specifi c with detrimental eff ect on skin and acne.11 perifollicular lymphocy c infi ltra ons and later evolve into intense necrosis. O en there is no 8. Acne fulminans scarring alopecia but cases may overlap with folliculi s decalvans. Non-specifi c excoria ons, Acute onset ulcera ve acne with systemic pityrosporum folliculi s, acute bacterial folliculi s, symptoms cons tutes acne fulminans. The lesions classic acne or acni s may be considered in the are mostly truncal and is associated with fever, diff eren al diagnosis. arthri s, weight loss, anorexia, malaise, bone pain, organomegaly and marked leucocytosis. There is poor response to ordinary therapy 13. Acne Rosacea responds good to systemic steroids, re noids and Papulo-pustular rosacea was previously known as dapsone. acne rosacea. The term is not preferred nowadays. 9. Acne inversa / Hidradeni s suppura va / 14. Acne tarda / Acne adultorum: Verneuil's disease / Smoker's boils Acne tarda also called adult acne is defi ned It is a chronic occlusive disease aff ec ng the as acne that develops or persists a er the apocrine gland bearing sites of the body, i.e. age of 25.19 It usually specifi es infl ammatory axilla, anogenital area, Inframammary areas, acne in the lower facial region or widespread post auricular areas and.12 It is characterized by macrocomedones especially in women. The painful, infl amed, deep seated nodules, sterile e ology is controversial and evalua on of features abscesses and/or fi brosis. rela ng hyperandrogenism is necessary. 10. Acne keloidalis nuchae / Folliculi s keloidalis 15. Acne vermoulan / Atrophoderma vermiculata / nuchae Folliculi s ulerythematosa re culata The term is a double misnomer as unlike acne, This atrophic variant of keratosis pilaris is a rare comedones are absent and unlike keloids, genodermatoses presen ng as an infl amed, the scars generally do not recur following re culate atrophic scarring of the face.20,21 It excision and aff ected pa ents do not develop starts with erythematous follicular papules on keloids elsewhere. It is an idiopathic, chronic, the cheeks in childhood which later progresses to infl ammatory process involving the hair follicles form “worm eaten” or “honey combed” re cular of occiput and nape of neck characterized by atrophy, the morphological hallmark of the the forma on of papules and pustules that may disease. eventually develop into fi rm nodules.13 16. Acne venenata / Chloracne 11. Acne mechanica The term specifi es acne induced by systemic It represents acneiform erup ons caused exposure to various halogenated aroma c by mechanical or fric onal obstruc on of hydrocarbons ‘chloracnegens’.22 The exposure can pilosebaceous outlet caused by pressure, be occupa onal or environmental and is common occlusion, fric on, or heat.14 “Fiddler’s neck” also presents with mul ple comedones ini ally over called “violin hickey” is a form of acne mechanica the temporal retroauricular area, mandibular NJDVL 60 area and sides of neck. It may progress to involve and fi brosis (poten ally induced by mast cells) in the axilla, scrotum, extremi es, trunk and the background of chronic infl amma on.26 bu ocks. Dioxin is the most potent environmental chloracnegen. There is presence of epidermal 22. Neonatal Acne / Neonatal cephalic pustulosis cysts with no sebaceous gland hypertrophy and These are infl amed papulo-pustules arising hence is a form of acne that does not respond to primarily on the cheeks, nasal bridge, forehead, isotre noin. chin, neck or upper trunk is the neonatal period. Acne venenata are acne induced on exposure to Comedo lesions and scarring are rare. Today it external chemical agents. is considered to be an infl ammatory reac on to commensal Malassezia (furfur, sympoidialis).27 17. Acne vulgaris Is the term commonly employed for common 23. Neutrophilic dermatosis associated with acne acne. Some common abbrevia ons of acne associated with neutrophiic dermatoses include SAPHO 18. Follicular occlusion tetrad syndrome (synovi s, acne, pustulosis, hyperostosis It is a disease complex comprising of hidradeni s and ostei s), PAPA syndrome (Pyogenic arthri s, suppura va, acne conglobata, dissec ng celluli s pyoderma gangrenosum and acne), PASH of the scalp and pilonidal sinus.23 The triad syndrome (Pyoderma gangrenosum, acne and comprising of former three disorders is called suppura ve hidradeni s) and PAPASH syndrome follicular occlusion triad. (Pyogenic arthri s and PASH syndrome). 19. Gram nega ve folliculi s 24. Picker’s acne / Acne excoriee It is a form of gram nega ve bacterial folliculi s It is a form of compulsive neuro c habit of picking that mimics acne.24 It is a complica on of and squeezing acne lesions to produce secondary prolonged oral or topical an bio c therapy, in lesions. par cular tetracycline. Sudden onset mul ple follicular pustules occur in perinasal and perioral 25. Pomade Acne areas. Two types have been described: type I, Pomade is a scented ointment or oil for dressing the most common (80%), with mul ple papules the hair o en used by Afro-Caribbeans. Hair oil and pustules in mid face and type II characterized or such products may cause acne like erup ons by infl ammatory nodules and cysts. Systemic consis ng mainly of closed comedones over the an bio cs including ampicillin, cephalosporin and forehead and temples.
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