By Gary M. White, MD
Various acneiform eruptions triggered by sun exposure have been described.
Patients with actinic folliculitis develop a recurrent pustular eruption of the face, typically appearing 4-6 hours after exposure to sunlight.
The rash of actinic superficial folliculitis is characterized by monomorphous, superficial, follicular pustules that appear on the back, upper chest, and shoulders annually after the first sun exposure of the year. The lesions resolve on their own within 10 days. Recurrences may occur under similar conditions after a latency period of at least 4 weeks. A similar eruption has been reported during UV phototherapy.
Acne aestivalis (also known as Mallorca acne) is similar if not identical to actinic superficial folliculitis and was first described in Scandinavians who, after a long dark winter, went on vacation (commonly to the island of Mallorca) and bathed in the warm sun. Within 1-2 days, they would develop inflammatory papules 2-4 mm in diameter, of the trunk, sparing the face. The condition would repeat each summer. Patients were usually 20-40 years of age, without a recent history of acne.
With avoidance of sun, the lesions resolve within 5-10 days without scarring.
A 29-year-old man presented with a 5-year history of an intermittent follicular rash. These eruptions occurred on his back and chest only when he was exposed to the sun, with his shirt off. They developed 24 to 36 hours after the first sun exposure of the year and resolved spontaneously after 5 to 7 days. Examination showed follicular pustules of the trunk. Actinic Superficial Folliculitis. J Cutan Med Surg. 2012 May-Jun;16(3):191-3
A 29-year-old woman who presented with a 10-year history of a recurrent pustular eruption affecting her face, typically appearing 4-6 h after exposure to sunlight. Actinic Superficial Folliculitis. Clin Exp Dermatol. 2005 Nov;30(6):659-61
A 30-year-old man presented with an extensive superficial follicular pustulosis on his back, shoulders and upper chest after exposure to intense heat and subsequent sweating on a sunny day. The pustules arose within 24-36 h afterwards. Histology and immunohistochemistry revealed subcorneal pustules, suppurative folliculitis and an infiltrate consisting of T cells, macrophages and neutrophils around the hair follicle, sebaceous glands and small vessels. Actinic Superficial Folliculitis. J Eur Acad Dermatol Venereol. 2003 Sep;17(5):562-5
A 31-year-old man presented with a sterile follicular pustules on the shoulders, trunk and arms, recurring every year within 48-72 h of the year's first exposure to the sun. Actinic Superficial Folliculitis. Br J Dermatol. 1998 Jun;138(6):1070-4
Two women are presented with an identical facial eruption, consisting of severe outbreaks of folliculitic pustules occurring 6 to 24 h following periods of intense sun exposure and persisting for several days. Both failed to improve with standard acne treatments, but responded well to oral isotretinoin therapy. Actinic Follicultis Clin Exp Dermatol. 1989 Jan;14(1):69-71
This paper describes two patients who developed an extensive superficial pustular folliculitis on the upper part of the breast, back, shoulders and lateral sides of the upper arms, starting within 24-36 h after exposure to sunlight. Actinic Superficial Folliculitis. Br J Dermatol. 1985 May;112(5):603-6
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