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Acneiform Eruptions - Causes, Types, and Treatment

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Acneiform eruptions are a class of diseases that are determined by papules and pustules and have a resemblance with acne vulgaris. Read more to know.

Medically reviewed by

Dr. Dhepe Snehal Madhav

Published At December 23, 2022
Reviewed AtMarch 28, 2024


Acneiform eruptions are dermal conditions that are follicular eruptions that consist of papules and pustules. Breaks in the epithelium cause the follicular contents into the dermis to form acneiform eruptions that often resemble acne vulgaris. However, the major differentiating factor between acneiform eruptions and acne vulgaris is that the former does not have comedones; it can be found in areas where acne vulgaris is not found. The lesion has a characteristic nodule or papule, a pustule appearance, a papule is an area that is discolored, while a pustule is a pus-filled vesicle. It can be a result of medication, hormonal or metabolic abnormalities, a genetic condition, or a drug reaction.

What Causes Acneiform Eruptions?

  • Infections, genetic disorders, hormonal or metabolic abnormalities, drug reactions, chemical contact, friction, and pressure all these factors can cause the development of acneiform eruptions.
  • Other factors that can trigger or cause acneiform eruptions include:

  1. Exposure to halogenated aromatic hydrocarbons.

  2. Use of antibiotics such as Penicillin and Macrolides.

  3. Reaction to drugs such as Nystatin, Corticotropin, Isoniazid, Naproxen, or Hydroxychloroquine.

  4. Microorganisms can also induce acneiform eruptions such as:

    1. Proteus.

    2. Enterobacter.

    3. Escherichia coli.

    4. Klebsiella.

  5. Malassezia furfur, which causes pityrosporum folliculitis, can also present as eruptions on the extremities and trunk.

  • It can also be caused by mycotic infections, secondary syphilis, Sporothrix schenckii, and cutaneous coccidioidomycosis.

  • It is also found in medical conditions such as eruptive cysts (rare follicular developmental abnormalities of the vellus hair follicles), nevus comedonicus (raised up papules that carry keratinous plugs), and tuberous sclerosis (a genetic disorder that induces tumors to expand in numerous portions of the body).

  • Increased excretion of causative substances can produce an inflammatory response.

What Are the Clinical Features of Acneiform Eruptions?

  • Acneiform eruptions can affect both genders and can occur at any age.

  • It is often seen in patients who are hospitalized and in individuals who are prone to infections or use antibiotics regularly.

  • Acneiform eruptions can present papules and pustules but do not present comedones.

  • They are seen over the back and trunk.

  • It can occur in areas other than the face, as opposed to acne vulgaris.

  • If acneiform eruptions are a result of a drug reaction, it disappears once the medication is discontinued.

  • In rare cases, nodulocystic lesions are also visible.

  • Acneiform eruptions look like acne but lack comedones.

  • A biopsy can be done for confirmation, which shows fungal or bacterial presence and mild inflammation.

What is the Differential Diagnosis of Acneiform Eruptions?

Acneiform eruptions are differentiated from acne vulgaris by:

  • History of sudden onset.

  • It can develop at any age.

  • Monomorphic morphology (single form and structural pattern).

  • Affects the trunk more than the face.

  • It affects areas where there are sebaceous glands.

  • Most cases of acneiform eruptions can be diagnosed clinically; on rare occasions; however, a biopsy can be done, or a culture of a discharge may be performed. Withdrawing a suspected medication can also be a diagnostic parameter.

What Are the Different Types of Acneiform Eruptions?

Acneiform eruptions are of different types, such as:

Drug-Induced Acne:

Numerous medications can cause acneiform eruptions, such as:

  • Corticosteroids.

  • Anticonvulsants such as Phenytoin.

  • Antipsychotic drugs such as Olanzapine and Lithium.

  • Antituberculosis drugs such as Thiourea, INH, Thiouracil, Disulfiram, Corticotropin,

  • Antifungals such as Nystatin and Itraconazole.

  • Other drugs such as Hydroxychloroquine, Mercury, Naproxen, Amineptine, chemotherapy drugs, and growth factor receptor inhibitors.

  • Antibiotics such as Penicillins and macrolides can cause eruptions without comedones. Other antibiotics include Doxycycline, Cotrimoxazole, Chloramphenicol, and Ofloxacin.

Steroid acne presents as papulopustular and is located on the trunk and extremities and has a similar form and is less frequently seen on the face. Lesions start appearing after administration of systemic corticosteroids; however, topical application of corticosteroids can also cause acneiform eruptions. The area where the medication is applied or around the nose or mouth in the case of inhaled steroids are the areas affected.

Occupational Acne:

Exposure to substances such as:

  • Chloronaphthalene and chlorophenyl are used as conductors and insulators.

  • Chlorophenols which are fungicides and insecticides, can cause acneiform eruptions.

  • Chemicals that contain iodides, bromides, and other halogens can induce acneiform eruptions; they are similar to steroid eruptions, but iodide-induced eruptions are more severe.

  • Occupational exposure can be through inhalation, direct contact, ingestion, or food; these can induce eruptions which are called chloracne. This chloracne are polymorphous (that is, they are different in form) cyst or comedones. The comedones are caused without inflammation.

  • In addition to the comedones, pigmentations and xerosis are also found. Internal organs such as the central nervous system, eyes, and liver may also be affected.

  • Some of these agents may be oncogenic.

  • Patients should be tested for ophthalmic, neurologic, and hepatic abnormalities.

Mechanical Acne:

  • Friction and pressure can induce acneiform eruptions.

  • This is found on the neck of violin players, under bra straps, under armbands, and in patients who are paralyzed or immobile.

  • A recurrent papulopustular eruption can be seen on extremities, trunk, and face in the case of allergic hypersensitivity, which causes eosinophilic pustular folliculitis.

  • It is generally seen in the third or fourth decades of life.

  • Ophthalmic involvement includes conjunctivitis, iritis (inflammation of the iris), blepharitis (inflammation of the eyelid), hypopyon iritis (inflammation of the anterior uvea and iris), iridocyclitis (acute inflammation of the iris and ciliary body), and keratitis (inflammation of the cornea).

  • This condition can be triggered by extreme weather conditions, spicy or hot foods, ingestion of high doses of vitamin B6, alcohol, and mites.

Chemical Acne:

Exposure to certain chemicals, such as waxes, heavy oils, cutting oils, coal tar derivatives, cheap pomade oils, and vegetable oil cosmetics, can cause acneiform eruptions.

How to Treat Acneiform Eruptions?

  • Treatment of the condition is based on the cause of acneiform eruptions.

  • If it is a drug reaction, the medication should be discontinued. In such cases, the patients recover within a few weeks. Prescription for acne can be conveniently accessed through telemedicine platforms available on websites

  • Avoiding drugs that can induce eruptions and reducing friction can reduce mechanical acne. Proper use of protective equipment and reducing exposure to chemicals can reduce occupational acne.

  • Other treatment modalities are available such as laser ablation, topical or oral antibiotics, excision, and oral retinoids.

  • Oral and topical retinoids have shown positive results. They decrease the production of sebum which helps resolve eruptions. However, pregnant women should not be prescribed retinoids as they have teratogenic potential.

  • Fungal infections such as pityrosporum folliculitis can be treated with topical antifungals such as Econazole, Ketoconazole, and Ciclopirox.

  • Chloracne treatment can take years, even if the exposure has been avoided.

  • A treatment used for acne vulgaris is not helpful for acneiform eruptions; however, salicylic acid and benzoyl peroxide is beneficial in reducing oily skin.

  • Antihistamines can help manage the itching, which is a common symptom, especially first-generation antihistamines can be of added benefit if the itching is nocturnal.

  • Dapsone can be used in some cases. Eosinophilic pustular folliculitis can be managed by Indomethacin; if it fails, Cyclosporine can be used, and short courses of dapsone also can be used.

  • If the culture report shows the presence of gram-positive bacteria, Doxycycline can be used.


Acneiform eruptions are a skin condition that resembles acne vulgaris but lacks comedones. They can be caused due to mechanical irritation, exposure to certain chemicals or even response to drugs introduced. They are found in areas such as the trunk or extremities and not the face, unlike acne vulgaris. They can be treated according to the causative factor, such as antibiotics for infection, removal of friction in mechanical acne, avoiding chemical contact in chemical acne, and discontinuation of the drug, in drug acne.

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Dr. Dhepe Snehal Madhav
Dr. Dhepe Snehal Madhav



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