Eponymous Names in Acne

Numerous terminologies have been linked to acne and related lesions which o en puzzles students and prac oners. Here we have tried to summarize some of the common acne related terms found in related literatures. 1. Acne aes valis / Mallorca Acne: It is reported as a seasonal recurrent acneiform erup on that starts in the spring, peaks in the summer and resolves therea er.1 It was ini ally reported from the islands of Mallorca. No cause has been delineated but may result from ultraviolet radia on. Dull red, dome shaped papules develop in the facial areas and upper trunk mostly in post adolescent women. The condi on responds well to topical re noids.


Eponymous Names in Acne
KC Shekhar 1 1 Resident, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal N umerous terminologies have been linked to acne and related lesions which o en puzzles students and prac oners.Here we have tried to summarize some of the common acne related terms found in related literatures.

Acne aes valis / Mallorca Acne:
It is reported as a seasonal recurrent acneiform erup on that starts in the spring, peaks in the summer and resolves therea er. 1 It was ini ally reported from the islands of Mallorca.No cause has been delineated but may result from ultraviolet radia on.Dull red, dome shaped papules develop in the facial areas and upper trunk mostly in post adolescent women.The condi on responds well to topical re noids.

Acne agminata / Acni s / FIGURE (Facial idiopathic granulomas with regressive evolu on) / Lupus miliaris disseminatus faciei /:
The word "agminata" is derived from the La n word "agmen" meaning cluster. 2 The disease is named so because there are acne like papules clustered around the eyes or mouth.
It is an uncommon but yet dis nct and chronic infl ammatory granulomatous dermatoses of young adults. 3,4It is characterized by asymptoma c discrete, symmetrical, reddish brown to pink monomorphic papulopustular erup on on the "muzzle" areas of face (cheeks, chin, eyebrows, eyelids and forehead).Involvement of body parts including axilla, groin, genitals, scalp, trunk and neck have been described.Histology reveals sca ered dermal granulomas composed of epitheloid and some giant cells with central casea on, which is evident as apple-jelly nodule like appearance on diascopy.Ini ally described as disseminated follicular lupus in the background of granulomatous histology, is now considered to be a self resolving variant of granulomatous rosacea. 5,6It was previously also known as facial papular tuberculid and lupoid rosacea.
Occupa ons involving hot and humid environment as cooks may develop acne as a result of excess hydra on and blockade of pilosebaceous duct.

Acne corne
Follicular horny pigmented papules involving the dorsa of hands, arms, legs, face or thorax which may later disseminate to involve markedly around the genitalia has been termed acne corne 7 .It is thought to result from crude petroleum, tar oil or paraffi n products and closely resemble pityriasis rubra pilaris or lichen spinulosus.

Acne conglobata
It is a severe, chronic, infl ammatory variant of acne characterized by infl amed papules, tender nodules and abscesses which coalesce to form draining sinuses involving the trunk. 8It commonly aff ects adult males in second to third decade with minimal systemic upset.

Acne cosme ca
Among the various forms of induced acne, cosme c acne refers to acne induced by cosme cs. 8 Comedone forma on occurs following the use of cosme cs containing comedogenic ingredients which includes lanolin, petrolatum, butyl stearate, lauryl alcohol, oleic acid, vegetable oils.Dark skinned individuals are more aff ected as they are liable to use opaque and oil containing make-up for camoufl age of acne and pigmenta on.Acne venenata is the term previously used for acne induced by contact with exogenous agents.
Radia on acne follows irradia on of the skin following deeply penetra ng radia on.

Acne cyst / Nodulocys c acne
The term acne cyst is a misnomer as they are not truly lined by an epithelium and are not true cysts. 9Pseudocysts or nodules are more appropriate terminologies for these lesions.

Acne detergicans
Obsessive use of soaps, cleansers, scrubs and related products by pa ents with common acne may aggravate the disease and result in its extension to unusual loca ons and hence called acne detergicans. 10Soap and related products are generally discouraged as they produce further detrimental eff ect on skin and acne. 11

Acne fulminans
Acute onset ulcera ve acne with systemic symptoms cons tutes acne fulminans.The lesions are mostly truncal and is associated with fever, arthri s, weight loss, anorexia, malaise, bone pain, organomegaly and marked leucocytosis.
There is poor response to ordinary therapy responds good to systemic steroids, re noids and dapsone.

Acne inversa / Hidradeni s suppura va / Verneuil's disease / Smoker's boils
It is a chronic occlusive disease aff ec ng the apocrine gland bearing sites of the body, i.e. axilla, anogenital area, Inframammary areas, post auricular areas and. 12It is characterized by painful, infl amed, deep seated nodules, sterile abscesses and/or fi brosis.

Acne keloidalis nuchae / Folliculi s keloidalis nuchae
The term is a double misnomer as unlike acne, comedones are absent and unlike keloids, the scars generally do not recur following excision and aff ected pa ents do not develop keloids elsewhere.It is an idiopathic, chronic, infl ammatory process involving the hair follicles of occiput and nape of neck characterized by the forma on of papules and pustules that may eventually develop into fi rm nodules. 13

Acne mechanica
It represents acneiform erup ons caused by mechanical or fric onal obstruc on of pilosebaceous outlet caused by pressure, occlusion, fric on, or heat. 14"Fiddler's neck" also called "violin hickey" is a form of acne mechanica in violinists. 15Stump acne is a mechanical acne occurring over operated stumps and immobility acne in pressure zones due to prolonged bed rest. 16.Acne necro ca / Acne varioliformis / Acne frontalis / Necro zing lymphocy c folliculi s / Acne necro ca miliaris : It represents chronic relapsing papulo-pustular lesions in the area of the hairlines and on the scalp. 17Discrete excoriated follicular papules on the scalp demonstrate necro zing lymphocy c folliculi s. 18 Early lesions are non-specifi c with perifollicular lymphocy c infi ltra ons and later evolve into intense necrosis.O en there is no scarring alopecia but cases may overlap with folliculi s decalvans.Non-specifi c excoria ons, pityrosporum folliculi s, acute bacterial folliculi s, classic acne or acni s may be considered in the diff eren al diagnosis.

Acne Rosacea
Papulo-pustular rosacea was previously known as acne rosacea.The term is not preferred nowadays.

Acne tarda / Acne adultorum:
Acne tarda also called adult acne is defi ned as acne that develops or persists a er the age of 25. 19 It usually specifi es infl ammatory acne in the lower facial region or widespread macrocomedones especially in women.The e ology is controversial and evalua on of features rela ng hyperandrogenism is necessary.

Acne vermoulan / Atrophoderma vermiculata / Folliculi s ulerythematosa re culata
This atrophic variant of keratosis pilaris is a rare genodermatoses presen ng as an infl amed, re culate atrophic scarring of the face. 20,21It starts with erythematous follicular papules on the cheeks in childhood which later progresses to form "worm eaten" or "honey combed" re cular atrophy, the morphological hallmark of the disease.

Acne venenata / Chloracne
The term specifi es acne induced by systemic exposure to various halogenated aroma c hydrocarbons 'chloracnegens'. 22The exposure can be occupa onal or environmental and is common presents with mul ple comedones ini ally over the temporal retroauricular area, mandibular area and sides of neck.It may progress to involve the axilla, scrotum, extremi es, trunk and bu ocks.Dioxin is the most potent environmental chloracnegen.There is presence of epidermal cysts with no sebaceous gland hypertrophy and hence is a form of acne that does not respond to isotre noin.Acne venenata are acne induced on exposure to external chemical agents.

Acne vulgaris
Is the term commonly employed for common acne.

Follicular occlusion tetrad
It is a disease complex comprising of hidradeni s suppura va, acne conglobata, dissec ng celluli s of the scalp and pilonidal sinus. 23The triad comprising of former three disorders is called follicular occlusion triad.

Gram nega ve folliculi s
It is a form of gram nega ve bacterial folliculi s that mimics acne. 24It is a complica on of prolonged oral or topical an bio c therapy, in par cular tetracycline.Sudden onset mul ple follicular pustules occur in perinasal and perioral areas.Two types have been described: type I, the most common (80%), with mul ple papules and pustules in mid face and type II characterized by infl ammatory nodules and cysts.Systemic an bio cs including ampicillin, cephalosporin and cotrimoxazole combined with oral isotre noin are o en helpful.

Infan le Acne
Here acne presents typically between 3 to 12 months of age.They tend to be more infl amed along with comedones and or scarring.Rather than maternally passed androgens, the pathogenesis is thought be because of transient premature produc on of androgens from the infan le adrenals. 25

Morbihan's syndrome / Solid facial edema
It is a rare en ty characterized clinically by chronic woody erythematous indura on localized on the forehead, glabella, eyelids, or cheeks.This en ty has also been described in rosacea and is believed to occur because of impaired lympha c drainage and fi brosis (poten ally induced by mast cells) in the background of chronic infl amma on. 26

Neonatal Acne / Neonatal cephalic pustulosis
These are infl amed papulo-pustules arising primarily on the cheeks, nasal bridge, forehead, chin, neck or upper trunk is the neonatal period.
Comedo lesions and scarring are rare.Today it is considered to be an infl ammatory reac on to commensal Malassezia (furfur, sympoidialis). 27

Picker's acne / Acne excoriee
It is a form of compulsive neuro c habit of picking and squeezing acne lesions to produce secondary lesions.

Pomade Acne
Pomade is a scented ointment or oil for dressing the hair o en used by Afro-Caribbeans.Hair oil or such products may cause acne like erup ons consis ng mainly of closed comedones over the forehead and temples. 28

Pseudoacne of the nasal crease
Milia, cysts and comedones presen ng in the early childhood and lined up horizontally in the lower third of the nose are the pseudoacne lesions. 29This transverse crease corresponds to the separa on point between the alar car lage and triangular car lage of nose.

Pyoderma faciale / Rosacea fulminans
The term was originally considered to be a variant of acne, but now is considered to be represen ng rosacea. 30It is also called as rosacea fulminans.It is a disorder primarily aff ec ng post-adolescent women and is characterized by fulminant erup on of infl ammatory papules, pustules and nodules on the face but rarely comedones.The lesions are frequently preceded by fl ushing.