{*Acne Necrotica}
Summary
Acne necrotica is an inflammatory disorder of unknown etiology centered on the hair follicle that results in necrosis of the follicular epithelium and adjacent skin. It is also known as necrotizing lymphocytic folliculitis because of the histopathological findings of early lesions [1]. It represents approximately 1% of all biopsies of cicatricial alopecias [2]. However, alopecia is not a part of its clinical presentation, and this clinicopathological dissociation contributes to its underrecognition. Lesions begin as small, erythematous, follicular papules that are subtle and easily missed [3]. In this stage, histopathology features the characteristic perifollicular lymphohistiocytic infiltrate accompanied by spongiosis and keratinocyte necrosis within the external root sheath. The follicular papules develop umbilication and crusting secondary to the underlying necrosis in a few days. Biopsy findings in more evolved lesions are nonspecific, as seen in this case, and include a dense, mixed, inflammatory infiltrate around a necrotic follicular unit surrounded by epidermal and dermal necrosis. Clinicopathological correlation is essential for biopsies from older lesions because of the brevity of characteristic findings [3]. Over the following weeks, the crusts are sloughed, and punched-out varioliform scars remain. These scars represent a significant clinical clue to guide the diagnosis since early lesions are subtle or easily excoriated.
(Barrera-Godínez, 2022)
Symptoms
Apart from the scarring, other essential clues to distinguish from acneiform eruptions include pruritus and scalp involvement.
(Barrera-Godínez, 2022)
Diagnostic Criteria
Under Investigation
Diagnostic Tests
Under Investigation
Human Leukocyte Antigen (HLA) Associations
Under Investigation
Tissue-Type or Cell-Type Attacked
Under Investigation
Attacking Immune Cell Type or Process
Under Investigation
Treatment Modality
Under Investigation
Managing Specialist(s)
Under Investigation
Associated Infections
Under Investigation
Associated Toxins
Under Investigation
Research Authors
Under Investigation
Research Institutions
Under Investigation
Average Time from Symptom Onset to Diagnosis
Under Investigation
Last Updated
December 20, 2022
References
Barrera-Godínez A, Oliveros-Hernández AF, Gatica-Torres M, Martínez-Benitez B, Dominguez-Cherit J. Acne Necrotica in a Woman With Systemic Lupus Erythematosus and Systemic Sclerosis. Cureus. 2022 Mar 9;14(3):e23008. doi: 10.7759/cureus.23008. PMID: 35464589; PMCID: PMC9001242.
Pitney LK, O'Brien B, Pitney MJ. Acne necrotica (necrotizing lymphocytic folliculitis): An enigmatic and under-recognised dermatosis. Australas J Dermatol. 2018 Feb;59(1):e53-e58. doi: 10.1111/ajd.12592. Epub 2017 Feb 27. PMID: 28240342.