title: Acne necrotica (necrotizing lymphocytic folliculitis): An enigmatic and under-recognised dermatosis.
abstract: Acne necrotica is a disorder of adults of obscure aetiology, featuring repeated cropping of inflammatory papulonodules which rapidly necrotise, leaving varying degrees of superficial scarring with pathological features in early lesions of a necrotising lymphocytic folliculitis. A perceived diminishing interest in this entity in recent years prompted a prospective study of patients presenting to a dermatology practice over a 3-year period to reassess the prevalence of this disorder in general dermatological patients, leading to the identification of 47 patients (35 female) with features of acne necrotica, with histopathology undertaken in atypical cases. We identified the importance of the recognition of primary lesions (1-2 mm umbilicated erythematous papules), often difficult to find in excoriated areas, as being paramount in the diagnosis both clinically and histologically in our study, which reveals a significantly more prevalent and clinically diverse disorder than featured in previous textbook and academic journal descriptions.
authors.affiliation: Queensland Institute of Dermatology, Greenslopes Hospital, Greenslopes, Brisbane, Queensland, Australia.
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Pitney
authors.affiliation: Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia.
authors.forename: Blake
authors.initials: B
authors.lastname: O'Brien
authors.affiliation: Sherwood Road Dermatology, Brisbane, Queensland, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pitney
mesh_terms: D000152:Acne Vulgaris / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D005499:Folliculitis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012867:Skin / Q000473:pathology*; D055815:Young Adult
keywords: acne necrotica; dermal hypersensitivity; doxycycline; excoriation; necrotising lymphocytic folliculitis; neurosis; pruritus; urticarial dermatitis