Doxycycline in the treatment of acne agminata

Abstract

Acne agminata is an unusual centrofacial papular eruption that occurs in young adults. It runs a self‐limiting course with spontaneous resolution of the lesions over 12–24 months, often leaving disfiguring scars. Histologically it is characterized by dermal masses of tuberculoid granulomas with central caseation necrosis and many consider acne agminata to be a variant of granulomatous rosacea.1 Treatment of this condition with antibiotics,2 dapsone3 and oral steroids4 has been reported with variable success. We describe a patient with acne agminata who was treated successfully with doxycycline. A 30‐year‐old Indonesian woman presented with a 4‐month‐history of a pruritic papular facial eruption. Despite a short course of antibiotics prescribed by her general practitioner, her condition failed to improve and was becoming more extensive. On examination, the eruption consisted of multiple erythematous and gelatinous papules, predominantly on the cheeks, upper eyelids, glabella and ears (Fig. 1). Comedones and seborrhoea were absent. Apart from mild eosinophilia (an absolute count of 0.81 × 109/L), routine blood tests were within normal limits. Other investigations including serum calcium, antinuclear antibody, erythrocyte sedimentation rate and Mantoux test were normal or negative. A bacterial swab of the lesions revealed no growth of any pathogen. Skin biopsy taken from a facial papule showed granulomata in the upper‐ and mid‐dermis consisting of epithelioid and Langerhans' giant cells with central caseation necrosis (Fig. 2). Staining for fungi and acid‐fast organisms was negative, and Mycobacterium tuberculosis DNA sequences were not detected by polymerase chain reaction. This clinico‐pathological finding was consistent with acne agminata, and the patient was treated with doxycycline 100 mg twice a day. Within 6 weeks an improvement was seen. After 5 months of treatment all the papules had healed, leaving pitted scars.