Drug-induced acne and rose pearl: similarities (2024)

Abstract

Drug-induced acne is a common skin condition whose classic symptoms can be similar toa rose pearl, as in the case of a male patient presenting with this condition afterexcessive use of a cream containing corticosteroids.

Keywords: Acneiform eruptions, Drug eruptions, Skin diseases

Abstract

A acne medicamentosa é uma dermatose comum, que pode apresentar no seu quadroclássico semelhanças à pérola rosa, como no caso apresentado de um paciente do sexomasculino cujo quadro surgiu após uso intempestivo de creme contendocorticoesteróide.

Drug-induced acne, or drug-induced acneiform eruption, is an adverse effect of a series ofsystemic drugs, such as corticosteroids, lithium, vitamin B12, thyroid hormones, halogencompounds (iodine, bromine, fluorine, and chlorine), antibiotics (tetracycline andstreptomycin), antituberculosis drugs (INH), lithium carbonate, antiepileptic drugs(phenobarbital and hydantoin derivatives), cyclosporin A, antimycotics, gold salts,isotretinoin, clofazimine, epidermal growth factor receptor inhibitors (cetuximab,gefitinib, and erlotinib), and interferon-beta.^1,2 Usually, topical productssuch as cosmetics may lead to acneiform eruption in women, especially in the region of thechin.² Intravenous dexamethasoneand high doses of oral corticosteroids often induce typical acneiform eruptions, withlesions predominantly located on the chest and back.¹

Clinically, it is characterized by a sudden monomorphic eruption of inflammatory papulesand pustules, usually pruritic and follicular.^1,2,3 Punctiform vesicles occasionally appear in the center of papules,which may develop into small vesicopustules.^2,3 An important clinical aspectin the differential diagnosis of drug-induced acne is the fact that the skin lesions arenot preceded by visible comedones.⁴

Discontinuation of the drug leads to remission of symptoms. Antihistamines are recommendedin case of pruritus, and oral antibiotics are recommended in case of secondary infectionwith pustules or impetiginization.^2,3

We can observe the usual aspect of a papular follicular eruption and, on closer look, asmall papule carefully surmounted by a pustule, which might be a possible evolution into avesiculopustule, as cited in the literature, demonstrating the inexorable aspect ofdrug-induced acne (Figure 1). We highlight theabsence of comedones, which supports the diagnosis (Figures2 and ​and33).

The male patient reported an insect bite in the area of the anterior trunk and use of acream containing a combination of an antifungal agent, corticosteroid, and a topicalantibiotic, with progressive worsening of the lesion in 10 days and intense pruritus. Weopted for discontinuing the topical medication and prescribed a combination of clindamycinand benzoyl peroxide, obtaining total control of the condition in 14 days. Importantdifferential diagnosis includes pityrosporum folliculitis (Malassezia),which presents similar follicular papules and pustules. However, in spite of the treatmentrecommended in the literature, that is, topical and oral antifungal drugs, we observe slowhealing and frequent recurrences. Moreover, the use of topical antibiotics brings nobenefits, as reported above.

The nature of the lesions, with a pinkish erythematous aspect, resembles a rose pearl,highly used by ladies as a bead in necklaces and bracelets; however, in this case, withoutit* adornment function (Figure 4).⁵

Footnotes

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