Pomade Acne
Pomade acne is typically a follical-based acneiform eruption seen after polonged use of agents containing hydrocarbons with high melting points. Spontaneous resolution can occur months after discontinuation of the offending agents. Topical retinoids and o
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Pomade Acne Oge Onwudiwe and Valerie D. Callender
22.1
Introduction
Pomade acne (aka acne venenata) is considered a clinically distinct entity from the more common acne vulgaris. It is caused by the use of pomades applied to the hair and scalp in individuals of African descent with tight curly hair. Pomades are oil- or ointment-based hair care products used to lubricate the scalp and improve manageability of the hair. Pomade acne consists mainly of uniform, closely set comedones predominantly of the forehead and temple region. Involvement of the cheeks and ears has been documented as well [1]. It is said to be associated with little to no inflammation [2] which is in stark contrast with the comedones of acne vulgaris in which Halder et al. histologically found a marked inflammatory response in individuals with skin of color [3]. These lesions are primarily follicular and considered to be of very slow onset. Characteristically, pomade acne is limited to the comedonal stage but inflammatory papules, pustules, miliary cyst, and an erythematous and edematous phase have all been documented [1, 2].
22.2
Background
In 1954, Berlin described an acneiform eruption of predominantly the cheeks and secondly the forehead which was seen in children who applied paraffin oil to their scalp. The eruption consisted of uniform pinhead-sized papules, confined to the follicles. Some showed black points in the center while others a perifollicular inflammatory process. Few cysts and pitted scars were also seen. The disease was readily O. Onwudiwe, M.D. (*) • V.D. Callender, M.D. Callender Dermatology and Cosmetic Center, 12200 Annapolis Road, Ste 315, Glenn Dale, MD 20769, USA e-mail: [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_22, © Springer Science+Business Media New York 2014
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distinguished from the adolescent type of acne by the age of onset, the uniformity of the eruption, the overwhelming predominance of comedones, and finally the lack of seborrhea and lack of involvement of back and chest. Improvement was seen upon discontinuation of the use of paraffin oil to the scalp as well as the use of a comedo extractor and benzine to dissolve the oil [1]. In 1970, Plewig et al. described a similar eruption. This was seen in African American men who applied various grooming substances to the face and scalp. The observations in this study were confined to Negro male prisoners. The mean age was 30 but ranged from 21 to 53 years of age. Six products were found to be in common use among them: Noxzema, Wildroot, Dixie Peach, Royal Crown, and mineral oil. Common to these are high melting hydrocarbons. In the small study conducted, five of these pomades were applied to the backs of three African Americans and three Caucasian subjects for a period of 8 weeks. The formulation was applied every other day to a 4 cm square area. Occlusion was primarily maintained via the use of a polyethylene film. The control site
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