Acne Necrotica due to Phenylbutazone

Abstract

rash and diarrhoea on November 12 and all drugs were discontinued on November 15. As there had been no improvement, she was admitted to hospital on November 18. On examination she was grossly thyrotoxic, being extremely restless and excitable. The pulse rate was 120 per minute. The whole body was covered with a profuse, red maculo-papular rash. Some of the papules were follicular, but there was no purpura. The mouth and throat were erythematous, with numerous small areas of ulceration. No lymphadenopathy or splenomegaly was present. There was no pyrexia on admission. The white cell count was

Acne Necrotica (Varioliformis) – Case Report

“…Acne necrotica is a rare but clinically distinctive form of cicatricial alopecia with obscure pathogenesis. Most patients have an abnormal inflammatory reaction to the pathogenic microorganisms such as Propinibacterium acnes, Malassesia spp., Demodex folliculorum and, in more severe cases, Staphylococus aureus (7). Mechanical manipulations of pre-existing lesions such as rubbing and scratching may only exacerbate the disease but are not a cause (3,6).…”

“…Mechanical manipulations of pre-existing lesions such as rubbing and scratching may only exacerbate the disease but are not a cause (3,6). Association of acne necrotica with phenylbutazone treatment has been reported in only one patient (1,7). In rare cases of acne necrotica herpes simplex virus was identified in the lesions (6).…”

DRUG REACTIONS XII Cutaneous Reactions to Anti-rehumatic Drugs

“…A number of miscellaneous rashes have also been recorded and attributed to phenylbutazone, including erythroderma with lichenoid qualities (Gold, 1966), acne necrotica (Hunter, 1959), blisters confined to the extremities (Kelly, 1953), sterile abscesses at the sites of phenylbutazone solution injections (Side effects of Drugs, 1966) and erythema nodosum (Glotzer, 1953).…”

Primary Cicatricial Alopecia

“…Possible triggers include Staphylococcus aureus infection [76] and certain medications, including some that cause other forms of atypical lymphoid infiltration [104], as well the biologics imatinib and adalimumab [39,179]. The observation of increased Langerhans cells in the follicular epithelium and the common finding of clonality in the T-cell infiltrate lend further support to the notion of an antigenic trigger for disease.…”

“…Hypopigmentation may be seen in darker-skinned individuals [100]. In one case, S. aureus infection was reported in association with crusting [76]. In cases of nonscarring disease, regrowth after remission can take months.…”