Acne necroticans

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: ED81.Y

Tree 1910.

Acne varioliformis, acne frontalis, acne atrophica, necrotising lymphocytic folliculitis.

Not related to acne vulgaris, rare, necrotising, acneiform inflammation of the hair follicles. It is a special form of pyoderma or folliculitis decalvans.

  • Rare disease.
  • Manifestation after puberty.

  • Unclear aetiology.
  • It is unclear whether this is truly a disease in its own right.
  • Occasionally it is possible to isolate coagulase-negative staphylococci from pustule smears.
  • Unlike acne vulgaris, no comedones are visible.

Itchy, reddish papules and pustules, which become necrotic in the course and leave a varioliform scar after the scab has fallen off. No comedones objectifiable.

Coagulase-negative staphylococci objectify, but are not always present. Comedones should rather not be present.

Hair attachment zone.

Initially, lymphocytic infiltrates, which organise themselves into an intrafollicular, granulocytic abscess in the course of time. In addition, necrosis of the infundibular epithelia may occur.

Frequent recurrences.

  1. Fisher DA. Acne necroticans (varioliformis) and Staphylococcus aureus. J Am Acad Dermatol 1988;18:1136-8.
  2. Maibach HI. Acne necroticans (varioliformis) versus Propionibacterium acnes folliculitis. J Am Acad Dermatol 1989;21:323.
  3. Mueller H. [Contribution to the Therapy of Acne Necroticans (Boeck)]. Dermatol Wochenschr 1964;149:495-500.
  4. Conraths H. [Unilateral acne necroticans in monozygotic twins]. Z Haut Geschlechtskr 1955;18:169-70.