LETTER TO EDITOR

Year: 2019 I Volume: 2 I Issue: 1 I Page: 18

Unilateral truncal acne after laminectomy

Dr. Puneet Agarwal¹ , Dr. Uma Shanker Agarwal¹

¹ Department of Dermatology, SMS Medical College & Hospital, Jaipur, Rajasthan

Corresponding Author:
Dr. Uma Shanker Agarwal,
Department of Dermatology, SMS Medical College & Hospital, Jaipur, Rajasthan
Email : dr.uasg@gmail.com

How to cite this article:
Agarwal P, Agarwal US. Unilateral truncal acne after laminectomy. JDA Indian Journal of Clinical Dermatology 2019;2:18.

Sir,

Unilateral acne and related disorders (rosacea, seborrheic dermati¬tis, and demodicidosis) have been described in relation to paralyzed areas of different causes. We report a case of unilateral acne follow-ing laminectomy.

A 35-year-old male patient presented with papules and pustules predominantly located on one left half of trunk. The patient gave a history of an operation done in the neck region for cervical pain. He had undergone laminectomy for intradural extramedullarylesion in spinal canal at C7 level. Two weeks later, acne lesions appeared on left half of back. On examination there were pustular lesions present over back. The majority lesions were on the left half and a few on the other side. There were no lesions on face, chest and scalp. There was no history of any occlusive dressing in that area or any application of any medication. On further evaluation it was found that there was hypoaesthesia in the left side of back.

There have been several earlier reports of acne occurring in an unusual distribution. ‘Immobility acne’ occurring in the perioral region, following prolonged dental splinting after periodontal surgery¹. Frictional acne in concert violinists² and in those wearing headbands.³ The mechanism in these cases is possibly a hyperkeratinization response to local trauma or increased hydration of the pilosebaceous keratin. In cases of paralysis, including cases of Parkinson’s disease and spinal cord injury, it has been suggested that an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions. Seborrhoea is frequently seen in Parkinson’s disease. This is associated with a raised Sebum Excretion Rate (SER) and it has been noted that following treatment with L-dopa, the SER was significantly reduced3. In a study done by Thomas et at, it was shown that the SER on the forehead is not significantly different in paraplegics and control subjects, but that the SER below the neurological lesion in paraplegic subjects is significantly greater than normal(P<o-oo1)^{5. Cases with unilateral acne have also been reported earlier post facial nerve palsy.6,7,8 Thus in this case the cause for unilateral acne lesions might be due to an increased sebum excretion post laminectomy.</o-oo1)}

Figure 1: Unilateral truncal acne Click here to view

References:

1. Cunliffe WJ, Cotterill JA. The Acnes: Clinical Features, Pathogenesis and Treatment, 1975;1st edn, p. 38.W.B. Saunders, Eastbourne.

2. FRANK S.Uncommon aspects of common acne. Cutis 1974;14:817.

3. Wilenz JM, Berger RA. Hippie dermatology. Cutis 1971;8:42.

4. Burton JL, Shuster S. Effect of L-dopa on seborrhoea of Parkinsonism. Lancet 1970;ii:19.

5. Thomas SE, Conway J, Ebling FJG, Harrington CI. Measurement of sebum excretion rate and skin temperature above and below the neurological lesion in paraplegic patients. British Journal of Dermatology 1985;112:569-573.

6. Tagami H. Unilateral steroid acne on the paralyzed side of the face. J Dermatol. 1983;10:281-2.

7. Al-Ghambi Y, Junainah J. Unilateral steroid induced acne on the paralyzed side of the face. Gulf J Dermatol Venereol. 2014;21: 44-5.

8. Sudy E, Urbina F. Unilateral acne after facial palsy. An Bras Dermatol 2018;93:441-2.