Full text of DOI:10.2165/00128071-200001030-00006

Am J Clin Dermatol 2000 May-Jun; 1 (3): 187-189
1175-0561/00/0005-0187/$20.00/0
PRACTICAL DERMATOLOGY
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Acne Variants
Kurt Gebauer
Freemantle, Western Australia, Australia
Acne vulgaris is easily diagnosed and satisfying to treat, and it usually responds to simple therapies. In
contrast, the management of uncommon acne variants is often much more complex.
Fig. 1. This young boy with infantile acne presented at the age of 3 months with
lesions that had been present since birth. A biopsy taken by a plastic surgeon
had confirmed cystic acne. There were no systemic symptoms. General exam-
ination and review by a pediatrician indicated that the infant was otherwise
normal. His condition resolved very slowly with systemic erythromycin and
benzoyl peroxide. There was some residual scarring. All the lesions had re-
solved by the age of 12 months.
Fig. 2. This 35-year-old male with acne conglobata had had acne for most of his life.
The lesions had not improved with any previous therapy, and he required isotretinoin
for eventual control, although this was not achieved without consequent severe
scarring. The patient was nevertheless satisfied to have most of his lesions resolved
and accepted the scarring.

188
Kurt Gebauer
Fig. 4. This young Thai oil-refinery worker had chlor-acne. He was contaminated
by organchlorides in a fire at his refinery. There are no systemic changes and the
lesions have been present for some years (courtesy of Dr Tom Delaney).
Fig. 3. This 14-year-old schoolboy suddenly developed severe cystic acne, high
fever, arthralgias and elevated white blood cell count. He had commenced treat-
ment with isotretinoin 2 months previously for moderate cystic acne, and it ap-
peared that this had precipitated this episode of acne fulminans. All the lesions
shown appeared over a 2-week period. His management was complicated by
depression as well as refusal to attend school. There was significant post-treatment
scarring, which required dermabrasion as well as more complex surgical proce-
dures for improvement.
Fig. 5. This 24-year-old woman with pyoderma faciale had an uneventful pregnancy
5 months previously. After delivering a normal baby girl by spontaneous vaginal
delivery, she developed sudden explosive acne. When this photograph was taken,
her lesions had been present for about 2 months. She was managed with isotretin-
oin. patients who have developed pyoderma faciale are often subject to recurrences
and may have significant scarring.
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Am J Clin Dermatol 2000 May-Jun; 1 (3)

Acne Variants
189
Fig. 6. This 23-year-old Asian woman previously had minimal acne. She presented
shortly after her final university exams and was due to return home to Malaysia
after 6 years of post-graduate studies in Australia. She had been extremely
stressed about the outcome of her examinations as well as about her impending
return to her previous home life and culture. Her condition is a variant of acne
excoriée des jeunes filles. This is characterized by excoriation of acne lesions and
usually occurs in female patients. She was treated and her condition resolved
rapidly with low dose oral antibacterial therapy, in this case minomycin 50mg twice
daily, and azelaic acid cream. Patients with acne excoriée des jeunes filles are
very difficult to treat. Aggressive standard acne therapies are appropriate for pa-
tients such as the woman in this case. This will reduce the severity and number
of lesions so that few are left to excoriate. For those patients with the variant seen
in figure 7, treatment of the underlying psychological or psychiatric condition is
paramount. These patients need to be seen frequently and rapport established
for successful management.
Fig. 7. This 34-year-old office worker has an excoriated weeping ulcer on her right
ear which had failed to heal over more than 4 months. This is an uncommon form
of acne excoriée des jeunes filles that involves patients who have considerable
personality or psychiatric problems, most commonly an obsessive disorder.
Biposy revealed granulation tissue only. Severe trauma had been inflicted on the
facial tissue, leaving significant linear scarring. She has an extensive psychiatric
history and has not improved with a course of isotretinoin. At present she has no
lesions, but continues to develop ulcerated areas on her face and scalp. Her
prognosis is poor.
© Adis International Limited. All rights reserved.
Am J Clin Dermatol 2000 May-Jun; 1 (3)