An acneiform drug eruption is considered to be an important cutaneous drug-induced adverse effect. It has been described in patients taking both topical and systemic drugs [1], with the most involved classes being antimicrobials (tetracycline, streptomycin, isoniazid, clofazimine, and antimycotics), central nervous system (CNS)-acting agents (lithium, phenobarbital, and hydantoin derivatives such as phenytoin), chemotherapeutics (epidermal growth factor receptor - EGFR inhibitors such as cetuximab, erlotinib, and gefitinib, but also cyclosporin A), interferon (IFN), gold salts, etc. [1] [2] [3] [4]. Corticosteroids, in topical as well as systemic formulations, are particularly associated with an acneiform drug eruption in women [1]. The typical signs are characterized by the onset of skin lesions within several days after the introduction of drugs [5]. Erythematous follicular papules are the hallmark of an acneiform drug eruption [1] [3] [5] [6]. These lesions develop on the face, but also on the extremities, particularly on the forearms and buttocks, whereas the shoulders, the retroauricular area, and the superior portion of the trunk might serve as additional locations [1] [3] [5] [6]. The papules are further differentiated from acne vulgaris by the formation of punctiform vesicles in the center, followed by vesiculopustular progression [1]. Additional findings that exclude acne vulgaris are the absence of comedones that should normally precede the formation of acne, the older age of the patient (acne are primarily seen in adolescence), accompanying signs of systemic drug toxicity (eg. fever or malaise), and resolution of lesions after discontinuation of the drug [1] [5].

• Acneiform Eruption

  Drug-Induced Acneiform Eruptions T2 - Drug-induced Acneiform Eruptions AU - Do, Ha K. [indiana.pure.elsevier.com]

  We included all patients that received cetuximab from Acneiform eruption January to December. The most frequent cutaneous reaction was acneiform eruption. Holmes FA, O’ Shaughnessy J,. [cuhigyner.tk]

  The biopsy was compatible with an acneiform eruption. Acne vulgaris and acneiform eruptions. En su práctica reacciones adversas sospechadas reaccion adversa fecha. El Instituto Geografico Nacional de Guatemala implemento 17 Report. [voduhivodarage.tk]

  Follicular acneiform eruption induced by imatinib. J Eur Acad Dermatol Venereol. 2006;20:1368–70. PubMed Google Scholar 46. Lee JE, Lee SJ, Lee HJ, Lee JH, Lee KH. Severe acneiform eruption induced by cetuximab (Erbitux). [link.springer.com]

  TY - JOUR T1 - Acneiform eruption due to "megadose" vitamins B6 and B12. [unboundmedicine.com]

• Acne Vulgaris

  Additional findings that exclude acne vulgaris are the absence of comedones that should normally precede the formation of acne, the older age of the patient (acne are primarily seen in adolescence), accompanying signs of systemic drug toxicity (eg. fever [symptoma.com]

  Acne vulgaris is a polymorphic infl ammatory skin disease, clinically characterized by mixture of comedones, superficial and deep infl amed papules, pustules, and nodules. It is a chronic infl ammation of the pilosebaceous unit. [indiana.pure.elsevier.com]

  Some sources consider acne vulgaris part of the differential diagnosis for an acneiform eruption. [4] Other sources classified acne vulgaris under acneiform eruption. [5] MeSH explicitly excludes perioral dermatitis from the category of "acneiform eruptions [ipfs.io]

  Patient discussion about acne vulgaris Q. what is the best treatment for acne vulgaris A. [medical-dictionary.thefreedictionary.com]

  How is acne vulgaris treated? There are many safe and effective acne treatments. [dermcoll.edu.au]

• Skin Rash

  Skin rash A rash is an area of irritated or swollen skin. [icdlist.com]

  A review of the treatment options for skin rash induced by EGFR targeted therapies: Evidence from randomized clinical trials and meta-analysis. Radiol Oncol 2013; 47: 166–175. DOI: 10.2478/raon-2013-0014. [dermnetnz.org]

  Patients presenting with a skin rash or skin lesions should be thoroughly assessed for the possibility of such a relationship and, if one is found, should be treated (if necessary) and educated regarding the drug-induced skin disorder ( TABLE 2 ). [uspharmacist.com]

• Pigmented Scar

  scars, etc., if proper treatment is not administered. [dovemed.com]

• Follicular Plugging

  Although histology of INAH and steroid induced lesions showed several similarities like follicular plugging, retention cysts and perifollicular inflammation; the damage to the luminal cells and suppuration of the follicular wall which were demonstrated [ijdvl.com]

The diagnosis of an acneiform drug eruption rests on the ability of the physician to identify the key findings and establish the underlying cause. For this reason, a thorough patient history and a detailed physical examination are main steps in order to raise suspicion toward this entity. Recent administration of the previously mentioned pharmacological agents is perhaps the crucial piece of information that can be obtained. Other patient details, such as age, the presence of underlying disorders for which these drugs are used, and the pattern of rash distribution are equally important for making a presumptive diagnosis. Recognition of an acneiform drug eruption is mainly based on clinical grounds, but a biopsy with subsequent histopathological examination can be performed. Typical findings include spongiosis, disruption of the follicular epithelium and a nonspecific inflammatory reaction with both lymphocytes and neutrophils [5], whereas a suppurative follicular inflammation with a dense neutrophilic infiltrate is reported by other authors [6].

It provides dermatologists with the most recent developments in the treatment of acne and associated disorders. [books.google.com]

Treatment consists of discontinuing the glucocorticoid or protecting the skin from the inhaled product. Initial treatment includes topical antibiotics and sulfur preparations. [ime.acponline.org]

There are many safe and effective acne treatments. [dermcoll.edu.au]

Topical therapy is usually the best place to start treatment. 12 If tolerated, benzoyl peroxide is the simplest and most cost-effective treatment. Bacterial resistance to benzoyl peroxide has not been noted. [clinicaladvisor.com]

Prognosis Most cases resolve without complications but it may take 10-14 days for the rash to disappear. Patients with exanthematous eruptions will have mild desquamation as the rash resolves. [patient.info]

Perioral dermatitis, also a disorder of unclear etiology, is mainly observed in the young, white, female population as papulopustules with erythematous base. [emedicine.medscape.com]

[…] of comedones or any apparent infectious etiology, acne vulgaris is characterized by the presence of sebum and comedones. 2-4 Like EGFR, HER-2 receptors have been shown to play a role in keratinocyte differentiations in the skin 5 ; hence, the observed [jhoponline.com]

(Etiology) Drug-Induced Acne occurs as an adverse reaction of the body to certain medications that are taken for various conditions. [dovemed.com]

Other cutaneous eruptions that may superficially resemble acne vulgaris but that are not thought to be related to it etiologically are due to infection (e.g. gram-negative folliculitis) or unknown causes (e.g. acne necrotica or acne aestivalis). [karger.com]

Epidemiology [ 2 ] Hospital Episode Statistics from 1996 to 2000 logged 62,000 hospital admissions in England each year due to drug allergies and adverse drug reactions. [patient.info]

Drug-induced skin pigmentation: epidemiology, diagnosis and treatment. Am J Clin Dermatol. 2001;2:253-262. To comment on this article, contact [email protected] [uspharmacist.com]

Steroid-induced acneiform eruption Member Rated 0 Patient case no. 10804 Date added 02 June 2010 Patient details Age Adult Location India Localisation Head / face Primary Lesions Comedones Erythema papules Pustule Pathophysiology inflammatory skin appendage [dermquest.com]

The pathophysiology of acneiform eruption is poorly understood. [e-ijd.org]

Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol. 2005;16:1425–33. PubMed Google Scholar 56. Sladden MJ, Clarke PJ, Mitchell B. [link.springer.com]

Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: The McGraw Hill Companies, Inc; 2008:1661-1672. 7. Chia FL, Leong KP. Severe cutaneous adverse reactions to drugs. Curr Opin Allergy Clin Immunol. 2007;7:305-309. 8. [uspharmacist.com]

How can Drug-Induced Acne be Prevented? Currently, it may not be possible to prevent Drug-Induced Acne. Stopping the medication causing the condition as early as possible is important. [dovemed.com]

Prevention of acneiform rash caused by EGFR inhibitors includes topical corticosteroids (hydrocortisone 2.5%, alclometasone) and oral antibiotics (minocycline, doxycycline, or antibiotics covering skin flora) twice daily for at least the first 6 weeks [ascopost.com]

This is also known as a comedolytic treatment (“comedolytic” is the term used to describe a product or medication that prevents the formation of comedones such as whiteheads and blackheads). [dermcoll.edu.au]

All patients should be educated to avoid the offending agent to prevent further complications. [aocd.org]

Etanercept works by acting as a decoy receptor for TNF-α, thereby preventing it from binding cell surface receptors and subsequently decreasing inflammation. [mdedge.com]

1. Rosa DJ, Matias FAT, Cedrim SD, Machado RF, Sá AA, Silva VC. Acute acneiform eruption induced by interferon beta-1b during treatment for multiple sclerosis. An Bras Dermatol. 2011;86:336–338.
2. Du-Thanh A, Kluger N, Bensalleh H, Guillot B.Drug-induced acneiform eruption. Am J Clin Dermatol. 2011;12(4):233-245
3. Pontello Junior R, Kondo RN. Drug-induced acne and rose pearl: similarities. An Bras Dermatol. 2013;88(6):1039-1040.
4. Plewig G, Jansen T. Acneiform dermatoses. Dermatology. 1998;196(1):102-107.
5. Segaert S, Van Cutsem E. Clinical signs, pathophysiology and management of skin toxicity during therapy with epidermal growth factor receptor inhibitors. Ann Oncol. 2005;16:1425–1433.
6. Lee JE, Lee SJ, Lee HJ, Lee JH, Lee KH. Severe acneiform eruption induced by cetuximab (Erbitux) Yonsei Med J. 2008;49:851–852