Dlova et al. 10% of patients who attended clinic, 4th most common diagnosis in South Africa
Clinical presentation
Hyperpigmentation is a significant clinical manifestation
Acne hyperpigmented macules
Mechanism is not post-inflammatory - biopsy shows ongoing inflammation - better called peri-inflammatory hyperpigmentation - resolves with acne resolution, no treatment needed
Postacne hyperpigmentation index (PAHPI) - a new hyperpigmentation
Erythema is not visible
Papules and pustules can still be seen - palpate lesions
Tendency to underestimate the degree of severity
Hypertrophic and atrophic scarring
Abuse/Misuse of topical steroids
May be used to lighten skin or to treat acne associated with PIHR
May cause/exacerbate acne
Consider if unusual age of onset, clinical lesions are monomorphic with inflammatory papules or papulopustules, location of acne beyond the seborrhoeic zones, resistance to conventional therapy
Consider potency and duration of topical steroid being used
Look for other signs of topical steroid misuse
Can cause hypertrichosis
Monomorphic papules and pustules
Excessive striae
Hyperpigmentation over the joints and hypopigmentatin between the joints
DDx in skin of color
Pseudofolliculitis Barbae
Commonly occurs in persons with tick, tightly culed hair including men and women of African descent
Prevalence of 45-83% in africanamerican servicemen
Pathogenesis
Curly hair
Shaving technique
Mutation in hair-follicle keratin 75 (formerly K6hf): a substitution mutation in the 1A alpha-helical segment of the hair follicle-specific keratin 75 (formerly K6hf) has been demonstrated in individuals with PFB. This keratin is present in the companion layer of hair follicles and also in the medulla of hair shaft (present only in the beard region)
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