Acne necrotica of the scalp: What is it?

Pimples necrotica varioliformis and pimples necrotica miliaris

Pimples necrotica varioliformis (ANV) – DEEP SCARRING FORM

Pimples necrotic varioliformis is considered uncommon but it surely’s most likely far more frequent than we notice. We simply don’t communicate of this entity a lot any extra. Sufferers with pimples necrotic varioliformis develop crops of 1-2 mm papules (bumps) or pustules (“pimples” – besides they don’t have pus) that finish of therapeutic over with formation of a pitted scar. (varioloform means resembling rooster pox or variola).

When the lesions on ANM first begin they appear to be a purple bump however quickly type an umbilicated lesions that then goes on to type a pustules after which a crust after which scar. Sufferers affected by ANV are sometimes center aged girls (though males may be affected as effectively) and develop these lesions most frequently on the face (frontal hairline), scalp, nape but additionally can develop them on the chest and nostril, eyebrows (apparently in a seborrheic distribution). They’ll nonetheless be extra widespead within the scalp, face and trunk. The situation can come and go for years (ie. a recurrent course of) with outbreaks of only a few such bumps or a number of a whole lot. A few of the literature (primarily a 1988 article by Dr David Fisher) cites that affected sufferers usually tend to be concerned, or below nice strain – however this has not be firmly established.

Confirming the analysis of Pimples necrotica varioliformis (ANV)

The analysis of ANV is often made clinically – that means that an skilled doctor could make this analysis by wanting rigorously on the frontal hairline, scalp, brow/face and nostril and chest and eyebrows.Pitted scars is the important thing discovering that I search for. This an typically be discovered on the again of the scalp however actually anyplace the place the illness has affected together with the lateral eybrow. A biopsy may be useful if there’s uncertainty. Biopsy of an umbilicated papule sometimes exhibits a lymphocytic infiltrate across the hair follicle and this leads to large loss of life (necrosis) of the keratinocytes within the follicular sheath. Quite than the focal irritation within the outer portion of the follicle in lichen planopilaris, the irritation in ANV is widespread all through the keratinocytes within the sheath. The irritation could unfold into the dermis with so known as lymphocytic exocytosis and there could also be necrosis of the dermis too. Along with what is going on within the follicle itself, there’s additionally surrounding fluid accumulation (subepidermal edema) and lymphocytic irritation as effectively.

In recent times, there was a pattern to name the situation lymphocytic necrotizing folliculitis. Phrases corresponding to pimples frontalis are nonetheless used.

Remedy of Pimples Necrotica Varioliformis

The therapy of ANV typically begins as soon as the lesions have been cultured. I typically suggest beginning with cultures earlier than any kind of antibiotic is given. If the tradition comes again with an organisms, one can decide the appopriate antibiotic as this info is usually offered by the microbiology lab. If the cultures come again adverse, one can start emperical remedy with topical choices like topical clindamycin lotion, topical erythromycin gel and presumably a steroid as effectively. If ineffective, the dermatologist will typically prescribe an oral agent corresponding to doxycycline (50-100 mg twice every day) or isotretinoin (at a dose of 0.5 mg per kg). Choices corresponding to cephalexin or trimethoprin-sulfamethoxasole may be thought-about as effectively. I do imagine, as do others, that it’s crucial to cease the itch scratch itch cycle on this situation. Antihistamines may be thought-about as can low dose SSRI or SNRI antidepressants. If these antidepressants don’t assist, doxepin or tricylic antidpressants (amitriptyline 10-25 mg at night time may be thought-about).

So as to scale back the bacterial load on the physique and scalp, topical antibiotics (mupirocin) may be utilized to the nares, axillae, and groin. The nails needs to be trimmed very quick. Using an antibacterial wash may also be thought-about in resistant circumstances.

Pimples necrotica miliaris (ANM) – SUPERFICIAL FORM

The analysis of pimples necrotica “miliaris” should even be thought-about in all sufferers with pimples necrotica “varioliformis”. Nevertheless, sufferers with ANM often ONLY have a couple of lesions on the scalp at anybody time -although frontal hairline, face and chest may be affected in some sufferers). By ‘few’ I imply 8-10. The again of the scalp can significantly be affected. The scalp is the principle website in comparison with ANV the place the chest and face, eyebrows are additionally affected. The lesions seem as superficial exocoriated crusts and papules which are extraordinarily itchy. They’ll resemble pimples though it’s troublesome to really squeeze something out of them. In actual fact, it’s often troublesome to seek out the precise pimple lesions as a result of they’ve crusted over. The lesions in ANM do NOT heal with scars – and that’s the important thing differentiating issue from ANV. A hyperlink between micro organism corresponding to Propionibacterium acnes or Staphylococcus aureus and ANM has been proposed. Many researchers really feel that ANM is just a type of P acnes folliculitis of the scalp

Remedy of Pimples necrotica miliaris (ANM)

Remedy of ANM is just like ANV with topical steroids, topical antibiotics, and oral tetracyclines being useful.


ANV is extra frequent than all of us notice. We simply don’t discuss this situation anymore. The dermatologists Plewig and Kligman summarized it greatest of their 1993 textbook when the acknowledged “Consciousness of
this weird illness is a prerequisite for an correct analysis.”


Fisher DA. Pimples necroticans (varioliformis) and Staphylococcus aureus. J Am Acad Dermatol. 1988;18:1136-1138.

Kossard S, Collins A, McCrossin I (1987) Necrotizing lymphocytic folliculitis: the early lesion of pimples necrotica (varioliformis). J Am Acad Dermatol 16:1007–1014.

Pitney et al. Pimples necrotica (necrotizing lymphocytic folliculitis): An enigmatic and under-recognised dermatosis. Australas J Dermatol. 2018 Feb;59(1):e53-e58.

Plewig G and Kligman AM, eds. Pimples and Rosacea. 2nd ed. New York,NY: Springer Verlag NY Inc; 1993:500-505.

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