Acneiform eruptions – 12 cases

This quiz involves skin conditions similar to acne i.e. there are follicular papules and pustules. At times they may be difficult to distinguish from each other and from acne. Swabs and skin scrapings for microscopy, bacterial and fungal culture may aid diagnosis.

Acneiform eruptions may affect the face and neck. Acneiform eruptions on trunk are described as folliculitis, which may be due to infection, obstruction, or unknown irritant factors. Time course, distribution and appearance may be helpful in making a more accurate diagnosis.

Superficial staphylococcal folliculitis is often accompanied by deeper furunculosis (boils) and abscesses. Individual lesions are acute, tender, follicular pustules. Staphylococcal follicular pustules may also be seen in wound infections. In contrast, pustules accompanying impetigo are non-follicular and less symptomatic. Mild infections resolve without treatment, but topical antiseptics / antibiotics or oral flucloxacillin may be required for more troublesome infection. The quiz describes non-staphylococcal folliculitis.

For each of the twelve cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

Case 1

Mild periorificial (perioral) dermatitis

Periorificial dermatitis tends to favour the skin around the mouth and/or nose and/or eyes. There are clusters of erythematous papules or pustules, often with a scaly top, sparing the skin within a centimetre of the vermilion of the lip. Periorificial dermatitis is common in females in their 20s and 30s. It is treated by avoidance of face creams, and if necessary, a 6 to 12-week course of tetracycline or erythromycin.

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