Acne necrotica due to phenylbutazone

Acne Necrotica in Its Entirety: When It Starts, and After It Evolves

Acne necrotica is a rare disease, characterized by recurrent crops of inflammatory papules and papulo-pustules that rapidly become necrotic, leaving varioliform scars of varying extent. Here, I report the case of a 32-year-old male with early-stage disease and a 58-year-old male with late-stage acne necrotica. Both patients had a history of chronic, relapsing, umbilicated, and centrally necrotic erythematous papules and papulo-pustules involving the hairline and face. A diagnosis of acne necrotica was made based on the clinical presentation, and both patients started on topical mometasone furoate cream and doxycycline tablets and responded well. Herein I report this case to reappraise an under-recognized entity of acne necrotica.

Acne Necrotica (Varioliformis) – Case Report

Acne necrotica is a rare disease, characterized by repeated cropping of inflammatory papules and papulo-pustules, which rapidly necrotize and leave varying degrees of varioliform scars that may lead to cicatricial alopecia when terminal hair-bearing sites are involved. In early lesions, pathology shows necrotizing lymphocytic folliculitis. We report a 63-year-old male patient with chronic, relapsing, umbilicated and centrally necrotic erythematous papules and papulo-pustules involving the frontal hairline area, face, and neck. Histopathology showed epidermal spongiosis and lymphocytic exocytosis, extensive necrosis and destruction of the follicular epithelium, a dense diffuse lymphohistiocytic infiltrate and necrosis of the perifolicular dermis. The diagnosis of acne necrotica was made based on the correlation of clinical and histopathological findings. A complete clinical remission was achieved with topical erythromycin and benzoyl peroxide.