Case history
Case history
A teenage boy presents with closed comedones and slightly tender erythematous papules and pustules on his forehead, cheeks, chin, chest, and upper back. Small lesions developed a few years ago as he entered puberty, and they have progressively worsened over the last year. Previous lesions have left residual red-brown hyperpigmentation.
Other presentations
Acne is a feature of polycystic ovarian syndrome (PCOS). If a female patient presents with acne, obesity, oligo- or amenorrhea, or hirsutism, consider screening for hyperandrogenism. Treatment of acne should not be withheld whilst PCOS is investigated.[6] See Polycystic ovary syndrome.
Acne conglobata is severe, nodulocystic acne without associated systemic manifestations.[7] Acne fulminans is the most severe form of cystic acne, characterized by the acute onset of nodular and suppurative acne associated with multiple systemic manifestations, including fever, arthralgias, myalgias, hepatosplenomegaly, and osteolytic bone lesions.[7]
Acne mechanica is caused by persistent mechanical obstruction, often by clothing or sporting equipment, which occludes the pilosebaceous unit and results in comedones.[8] Acne excoriee describes acne in people who pick and scratch at comedones. This may be due to habit or be a form of body dysmorphic disorder (bodily focused anxiety). Acneiform eruptions can be caused by some drugs (e.g., androgens, topical or systemic corticosteroids) and occupational or environmental exposures (e.g., chloracne caused by dioxins).
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