Acne Necrotica in Its Entirety: When It Starts, and After It Evolves

Acne necrotica (AN) is a rare, chronic scarring condition affecting hair follicles, mainly on the face and scalp, and typically starts in the fourth and fifth decades of life, more commonly in females. It manifests as erythematous papules with central necrosis and hemorrhagic crusts, leading to varioliform scars. Diagnosis relies on clinical features and histopathology. Treatments include antibiotics like doxycycline and topical corticosteroids, but recurrence and significant scarring are common. The exact cause is unknown, but it may involve an abnormal inflammatory response to pathogens such as Cutibacterium acnes and Staphylococcus aureus.