Acne – Acne Necrotica (Acne Varioliformis)

Acne Necrotica is a common condition involving the scalp which I see on a routine basis in my Woodlands dermatology and Conroe dermatology offices.  The cause of acne necrotica is unknown but it usually occurs in adult men and less often in women in which red itchy acneiform papules arise spontaneously on the front and sides of the scalp.  These papules are usually centered around the pilosebaceous unit (hair follicle unit) and may be intensely itchy resulting in them becoming excoriated.  In severe cases, they resolve with scars which can cause permanent hair loss when the scarring extends into the subcutaneous layer (fat layer) of the skin.  Treatment is centered around antibiotics such as minocycline and doxycycline which can be used long term for hair follicle disease and function in both decreasing the bacterial load and minimizing inflammation.  I usually prescribe a topical antibiotic solution such as clindamycin to be used twice a day.  Most importantly, I admonish my patients to never scratch these lesions as trauma only worsens the scarring and hair loss.