Differential diagnosis of facial acne on black skin

Abstract

The diagnosis of acne is usually easy, but there are some pitfalls to be avoided. 'Keloid acne of the neck' and beard folliculitis are not acnes in the usual sense: both are inflammatory and fibrous reactions of the hair follicles and frizzy hair; no retentional lesions, blackheads and microcysts -are visible. Gram negative folliculitis classically occurs in acneic male subjects who have undergone extensive treatment with general antibiotics or local antiseptics, but 'de novo' cases do exist. On black skin, this condition is not exceptional, it occurs in both sexes and usually takes the nodular form. The diagnosis should be considered if there is any aggravation of acne which is resistant to classic treatment, with painful nodules on the cheeks. Treatment is based on appropriate antibiotherapy for several weeks and possibly, in a second phase, on Isotretinoin. Pityrosporum folliculitis occurs mainly on the trunk. More frequent in men than in women, it is chiefly observed in subjects living in a hot, humid climate. Demodicidosis is manifested by outbreaks of papular or papulopustular lesions of the face. On black skin the principal differential diagnosis is acne. The presence of numerous parasites is necessary for diagnosis. Clinically speaking, an important sign is when the eyelids are affected. Ivermectin is effective. Acneiform dermatitis may be induced by depigmenting preparations containing powerful dermocorticoids. It is therefore important, in cases of very inflammatory acne, to look for the other clinical signs of voluntary depigmentation. In countries where it is endemic, lepromatous leprosy should be considered.Other common dermatitis may simulate acne or else be associated with it, such as eruptive hidradenoma or molluscum contagiosum. Analysis of the different elementary lesions and the absence of retentional lesions generally enable a diagnosis to be established.

Malassezia: Zoonotic Implications, Parallels and Differences in Colonization and Disease in Humans and Animals

“…Malassezia folliculitis is another common worldwide disease with a prevalence of 1 to 17%. It occurs more commonly in young to middle-aged adult males [ 222 , 223 , 224 ]. Follicular occlusion or a disturbance of the normal cutaneous flora leads to an abnormal proliferation of Malassezia species and the development of disease.…”

“…Lesions include small but pruritic follicular papules and pustules. This presentation is often mistaken for acne or bacterial folliculitis [ 223 , 224 , 231 , 232 ].…”

Truncal acne, what do we know?

“…It presents as fine monomorphic, pruritic papules and pustules along the hairline and on the upper portion of the back 45,46 . It is more frequent in men than in women and is frequently observed in subjects living in hot, humid regions 47 …”

Advances in dermatology in sub‐Saharan Africa in the past 20 years from workshops to the birth of the African Society of Dermatology and Venereology

“…Highlights included presentations on five chronic diseases (AIDS, rheumatoid arthritis, systemic lupus erythematosus, pulmonary tuberculosis with cachexia, and Behçet's disease) which cause silky hair similar to African newborns 29 . Other topics were the Roberts skin type classification for grading of postinflammatory hyperpigmentation (PIH) 30 ; differential diagnosis of acne on black skin 31 ; and studies showing striking differences between Caucasian and African skin at the level of the dermal–epidermal junction 32 . Although dark, highly pigmented skin is less sensitive to ultraviolet light from a biological perspective, 33 an epidemiological study conducted in Nigeria emphasized the high prevalence of squamous cell carcinomas on black skin 34 .…”