What are the other Names for this Condition? (Also known as/Synonyms)

• Acne Atrophica
• Necrotizing Lymphocytic Folliculitis
• Pustular Perifolliculitis

What is Acne Necrotica? (Definition/Background Information)

• Acne Necrotica describes a rare skin disorder that typically affects young to middle-aged adults. It is a severe condition that is characterized by inflammatory hair follicle lesions that necrotize (die) on the hairlines
• Acne Necrotica is a chronically relapsing condition unrelated to the common skin condition acne. The skin lesions can lead to permanent scarring and hair loss; the condition can also recur
• The treatment measures for Acne Necrotica may include the use of topical applications, oral medications, antibiotics, and cosmetic procedures. The prognosis is dependent on the severity of the condition and varies from one individual to another

Who gets Acne Necrotica? (Age and Sex Distribution)

• Acne Necrotica is an uncommon condition that is mostly observed in adults in the 30-50 years’ age group
• Both males and females are affected, but a preference for females is noted
• Worldwide, individuals of all racial and ethnic backgrounds may be affected

What are the Risk Factors for Acne Necrotica? (Predisposing Factors)

No risk factors have been specifically reported for Acne Necrotica, which is described as a severe form of scalp folliculitis.

In general, some of the predisposing factors for scalp folliculitis include:

• Poor hair hygiene
• Frequently changing hair creams, hair lotions, and shampoos
• Shaving the head
• Exposure to unchlorinated waters in community pools and hot tubs
• Keeping the head covered frequently such as wearing tight caps and helmets
• Presence of acne or other skin infections
• Individuals with poor immunity

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acne Necrotica? (Etiology)

• The cause of the formation of Acne Necrotica, also known as Necrotizing Lymphocytic Folliculitis, is not well-established. The condition is not a subtype of acne but may be associated with scalp folliculitis
• Some researchers believe that the cause may be infectious as specific pathogens have been discovered in culture studies of the lesion discharge, notably Staphylococcus aureus and Corynebacterium acnes

What are the Signs and Symptoms of Acne Necrotica?

The signs and symptoms of Acne Necrotica may vary from one individual to another, and these include:

• Formation of red papules and pustules on the scalp and frontal (anterior) hairlines due to inflammation of the hair-follicles
• These skin lesions rapidly grow to larger sizes and die (necrotize), leaving behind black crusts
• On further healing, permanent scars resembling chickenpox may be noted
• Individuals may feel pain, burning sensation, and severe discomfort
• When the blisters rupture, and discharge pus, the hair around the lesion may clump together due to the fluid discharge
• The lesions may develop repeatedly after relapsing
• Apart from the scalp and face, other body areas may also be involved, such as the chest

The following two variants of Acne Necrotica are reported:

• Acne necrotica miliaria - these are highly itchy lesions that heal without scarring
• Acne necrotica varioliformis - here, the lesions form depressed scars that are pox-like (varioliformis)

How is Acne Necrotica Diagnosed?

A diagnosis of Acne Necrotica may involve the following:

• Physical examination and a complete medical history; a dermatologist will visually examine the lesions to help in the diagnosis
• Blood tests, analysis of pus, culture of the fluid being drained, as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis to exclude other similar skin conditions is important.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acne Necrotica?

Acne Necrotica can cause the following complications:

• Emotional and psychological stress
• Cosmetic issues
• Secondary bacterial and fungal skin infections
• Scarring of the affected region leading to permanent scarring
• Irreversible hair loss
• The infection may spread to other skin sites (cellulitis)
• Acne Necrotica may recur after completion of treatment. The condition is also known to relapse chronically

How is Acne Necrotica Treated?

The treatment of Acne Necrotica may involve the following:

• Use of topical antibiotic creams
• Application of steroidal lotions and ointments
• Administration of the oral medication isotretinoin
• Medications, such as antibiotics (doxycycline), may be used for bacterial infection
• Phototherapy
• Laser hair removal
• Minor surgery to drain pus from the lesions, if necessary

Self-care (home) remedies may include:

• Wash the lesions with mild soap (antibacterial)
• Wash hair regularly using a mild shampoo (anti-dandruff and anti-fungal) with conditioner, if needed
• Apply a warm compress
• Use lukewarm water to wash hair, and not hot water 
• Wash hands before applying topical applications
• Keep nails trimmed; do not pick at the scalp lesions
• Avoid shaving the head for some time
• Use a new razor each time to shave hair

How can Acne Necrotica be Prevented?

Presently, it may not be possible to prevent Acne Necrotica, since the cause of the condition is unknown; however, the following measures may be considered:

• Maintain good hair and body hygiene
• Minimize wearing of helmets, caps, and hats
• Avoid switching cosmetic hair care products often
• Take appropriate treatment for other skin conditions such as acne and dermatitis
• Do not use old and dull razors
• Avoid exposure to untreated swimming pools and hot tubs

What is the Prognosis of Acne Necrotica? (Outcomes/Resolutions)

• The prognosis of Acne Necrotica depends on the severity of the condition
• In many cases, despite adequate treatment, the condition may recur. It can also cause permanent scarring

Additional and Relevant Useful Information for Acne Necrotica:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken to avoid strong soaps and chemicals that could potentially worsen the condition.