The “bumpy” adolescent nose: Acne associated angiofibroma‐like nasal papules

Abstract

Background/Objective: Papular scars are a recently described clinical phenotype of acne scarring characterized by papules occurring on the nose and chin. We have observed a similar presentation of nasal papules among patients seen in our clinic for acne and sought to further characterize the clinical and histopathological characteristics of this entity. Methods: In this single-site case series, a retrospective review of electronic medical records of patients with nasal papules in association with acne vulgaris between April 2018 and April 2019 was performed. Clinical and histopathologic findings were recorded. Results: We identified 20 patients who presented with a similar clinical phenotype of predominantly skin-colored, dome-shaped papules concentrated on the nose and chin in association with a history of more classic facial acne vulgaris. Papular lesions were seen predominately in adolescent Hispanic males. Concomitant acne on other areas of the face was identified in 18 patients at presentation while two patients had a history of adolescent acne. Biopsies were performed for five patients. Histopathologic examination demonstrated features of fibrosis and dilated thinwalled blood vessels, typical of angiofibromas. Conclusion: We present a series of adolescent patients with large, flesh-colored to erythematous papules seen predominantly on the nose. These lesions are histologically indistinguishable from angiofibromas and may represent an under-recognized yet disfiguring sequela of acne that may disproportionately affect adolescents with skin of color.

How I Do It: Treatment of Papular Acne Scars of the Nose

“…1 Acne scars are most commonly found in darker skinned individuals. 2,5 Various treatment options for papular scars have been described, yet few have been proven successful. Another method involving cautery has been efficacious and safe in treating papular acne scars on the nose in 3 patients.…”

“…1 Acne scars are most commonly found in darker skinned individuals. 2,5 Various treatment options for papular scars have been described, yet few have been proven successful.…”

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How I Do It: Treatment of Papular Acne Scars of the Nose P apular scars, a less often discussed morphology, have been described and are reportedly most common on the nose and chin, particularly in skin of color. 1,2 Previously reported treatments for papular acne scars are flawed, and herein, we present an effective, safe treatment using an electrocautery machine (Hyfrecator 2000 Electrosurgical System, ConMed). Prior described treatments for papular scars include CO2 lasers, dermabrasion, chemical peels, the Erbium (ER): YAG laser, infrared lasers, and intralesional radiofrequency; although, these methods are not ideal for papular scars, given the pain, long healing time, technical expertise needed to operate a laser, and the cost.

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