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Acne necrotica
Other Resources UpToDate PubMed

Acne necrotica

Contributors: Mack Su, Susan Burgin MD
Other Resources UpToDate PubMed


Acne necrotica, also known as necrotizing lymphocytic folliculitis and folliculitis necrotica, is a rare disorder with a chronic relapsing course characterized by follicular papules and pustules, predominantly affecting the anterior hairline and scalp. It is typically seen between age 30 and 50, with most recent sources reporting a female predilection. The etiology of acne necrotica is unknown, although Staphylococcus aureus and Corynebacterium acnes have been isolated from the pustules. Despite its name, it is not a variant of acne.

The acne necrotica varioliformis variant is characterized by evolution of the papules and pustules to form depressed scars resembling those seen in smallpox (varioliform). These lesions may be painful with little to no pruritus. The acne necrotica miliaria variant is characterized by small vesicopustules that form superficial crusts and erosions without scarring. These lesions tend to be very pruritic.


L70.2 – Acne varioliformis

402923008 – Acne necrotica varioliformis of scalp margin
45072005 – Acne necrotica miliaris

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Differential Diagnosis & Pitfalls

  • Folliculitis – May be present elsewhere on the body and have sustained response to antibiotics
  • Folliculitis decalvans – Most frequently affects the crown; biopsy demonstrates a predominantly neutrophilic infiltrate
  • Acne vulgaris – comedones present and earlier onset
  • Dissecting cellulitis of scalp
  • Ofuji disease
  • Lupus miliaris disseminatus faciei
  • Erosive pustular dermatosis
  • Tinea capitis
  • Molluscum contagiosum
  • Herpes zoster
  • Eczema herpeticum
  • Acne excoriée
  • Factitial dermatitis

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Last Reviewed:08/24/2020
Last Updated:09/21/2020
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Acne necrotica
A medical illustration showing key findings of Acne necrotica : Scalp, Umbilicated papules, Frontal hairline
Copyright © 2024 VisualDx®. All rights reserved.