Complex Acne Disorders: Pyoderma Faciale…

Many of my photographs have been used in the Dermatology textbook Andrews’ Diseases of the Skin.  If you look at the latest edition you will see these first two images.

Pyoderma Faciale is an uncommon eruptive facial disorder consisting of a very fulminant onset of superficial and deep abscesses and cystic lesions.  At times sinus tracts may occur and scarring is inevitable.  It occurs in post adolescent women.  It is different than acne by the absence of comedones, extremely rapid onset, fulminant course and absence of acne anywhere else on the body.  Pyoderma Faciale is different from Acne Rosacea by lack of flushing history, absence of preexisting redness or telangiectasias and the presence of large abscesses and nodules that often express greenish or yellowish purulent material.  To read more about Acne Vulgaris click HERE.  To read more about Acne Rosacea click HERE.

I often like to reference DermNet NZ, it is a website out of New Zealand that does a pretty good job of being succinct and is a good quick reference.  Because it is a foreign dermatology source the terminology is sometimes a bit different.  To read about Pyoderma Faciale from this source click HERE.  You will note that this condition is also referred to as  “Rosacea Fulminans” by some in the literature but doesn’t fit the profile of Rosacea at all.  From the posting they do a good job of summarizing what we know…

Unlike Acne Vularis, Pyoderma Faciale:

  1.  Starts abruptly
  2.  Rarely persists more than a year
  3.  Is not associated with oily skin
  4.  Does not start with comedones
  5.  Is confined to the face
  6.  Does not affect males

Compared with Acne Rosacea, Pyoderma Faciale:

  1.  Affects younger women
  2.  Is not associated with flushing
  3.  Does not affect the eyes

So, as you can see, it is a very unique disorder with very specific features.

TREATMENT:  Therapy involves shutting down the inflammation with systemic steroids (like oral prednisone or intramuscular kenalog) and Accutane (isotretinoin) for 4-6 months.  The first patient shown above developed Pyoderma Faciale at onset of pregnancy which really made treatment difficult…I could not use Accutane because of the high rate of fetal abnormalities that are associated with this drug.  To read more about this disorder click HERE.  This article was written by Julian Choi (you will notice the images are the first patient I showed above), who works with William James, MD who is the chairman of the department of dermatology at the University of Pennsylvania.  He is also the senior editor for Andrews’ Diseases of the Skin.  Bill was my chairman at Walter Reed Army Medical Center when I was a resident, and I have been sending him slides for many, many years.  It has been such an honor to be associated with him.