Acne necroticans

Last Updated: 2020-06-15

Author(s): -

Baum 1910.

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

Rare, necrotizing, acne-like inflammation of the hair follicles not related to acne vulgaris. It is a special form of pyoderma or folliculitis decalvans.

  • Rare disease.
  • Post-puberty manifestation.
  • Unclear etiology.
  • It is unclear whether this is really an independent disease.
  • Occasionally it is possible to isolate coagulase-negative staphylococci from pus swabs.
  • Unlike acne vulgaris, no comedones are visible.

Itchy, reddish papules and pustules that become necrotic in the course of disease, and leave a varioliform scar after the scab has fallen off. No comedones are present.

Coagulase-negative staphylococci are detectable by swabs, but are not always present.

Very rare and disputed disease – be reluctant with making this diagnosis without solid evidence, and make sure you compare your case with peer-reviewed case reports.

Hair attachment zone.

Initially lymphocytic infiltrate, which in the course of time organizes itself into an intrafollicular granulocytic abscess. In addition, necrosis of the infundibular epithelia may occur.

Frequent relapse.

The initial treatment is both systemic and topical. Even after discontinuation of systemic therapy, external antiseptic therapy must be continued for a long period to prevent recurrences.

  • Topical antiseptics
  • Topical steroids
  • Isotretinoin p.o. 0,5-1 mg/kg bw 1x daily
  • Methylprednisolone (Medrol®) p.o. 0,5- 1mg/kg bw 1x a day
  • In second and third line tetracyclines or erythromycin.
  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.