What is acne agminata?
Acne agminata is an uncommon skin disorder characterised by red-brown lumps and bumps on the face, especially the eyelids, forehead, cheeks and chin.[1,2] It can also affect the armpits.[3,4]
It was first described by Tilbury Fox as disseminated folliculitis in 1878.
Other names for the disorder include:
- Lupus miliaris disseminatus faciei
- Facial idiopathic granulomas with regressive evolution
- Acnitis of Barthélemy
- Acne telangiectoides of Kaposi
- Tuberculodermas of the face 
- Facial idiopathic granulomas with regressive evolution (FIGURE)
*Courtesy of Dr Anthony du Vivier
Who gets acne agminata?
Acne agminata is most commonly found in young adults, although any age group may be affected.
What causes acne agminata?
The cause and risk factors for acne agminata remain unknown. It does not appear to be an infection, which has been considered because granulomas are seen on histopathology.
How is acne agminata diagnosed?
Acne agminata is often a clinical diagnosis.
Typical microscopic changes on skin biopsy include epithelioid granulomas within the dermis, which may be caseating even in the absence of tubercle bacilli.
Other investigations are not usually required once a diagnosis of acne agminata has been made, unless there is a suspicion of other diagnoses such as sarcoidosis or tuberculosis (TB), when the following tests may be considered if appropriate.
- Blood tests: full blood count, renal function, interferon gamma assays
- Imaging: chest X-ray
- Tuberculin skin testing (Mantoux)
Differential diagnosis of acne agminata
Clinical and histopathological diagnoses that should be considered include:
- Acne vulgaris: however, comedones are absent in acne agminata, and eyelids are not usally affected in acne
- Cutaneous TB
- Granuloma annulare
- Cutaneous leishmaniasis
What is the treatment for acne agminata?
Untreated, acne agminata persists for 2–3 years and then regresses with scarring.
Several treatments have been tried with some success including: