Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2025;15(3):5568 1

Dermoscopy of Acne Agminata in Fair  
and Dark Skin

Noemi Plozner1, Irene D’Odorico1, Enrico Pegolo2, Giuseppe Stinco1, Enzo Errichetti1 

1 Institute of Dermatology, Department of Medicine, University of Udine, Italy

2 Institute of Anatomic Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy

Citation: Plozner N, D’Odorico I, Pegolo E, Stinco G, Errichetti E. Dermoscopy of Acne Agminata in Fair and Dark Skin.  
Dermatol Pract Concept. 2025;15(3):5568. DOI: https://doi.org/10.5826/dpc.1503a5568

Accepted: March 23, 2025; Published: July 2025

Copyright: ©2025 Plozner et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. 

Corresponding Author: Noemi Plozner, MD, Institute of Dermatology, Department of Medicine, University of Udine, Piazzale Santa Maria 
della Misericordia, 15. 33100 – Udine, Italy. E-mail: noemiplozner@hotmail.it 

Case Presentations

We present the cases of two females typified by phototypes II  

(case 1) and IV (case 2), respectively. Both had a history of 

discrete papules on the central face, persisting for several 

months. Physical examination of the dark-skinned patient 

exhibited red-to-brown papules located on the nose and 

cheeks, while the fair-skinned patient displayed erythema-

tous papules primarily on the nasolabial folds and perior-

bital area (Figure 1, A and C).

Dermoscopically, both cases displayed follicular white 

plugs surrounded by either orange (fair-skinned patient) 

or yellow-orange (dark-skinned patient) structureless areas 

(Figure 1, B and D). Histopathological evaluation revealed 

follicular hyperkeratosis and dermal granulomas localized 

around the pilosebaceous units in both cases (Figure 1E) 

consistent with the clinical suspicion of acne agminata. 

Teaching Point

Acne agminata, also known as lupus miliaris disseminatus 

faciei, is an uncommon granulomatous condition of unclear 

etiology thought to result from an inflammatory response 

to damaged hair follicles [1]. Its histological hallmark is the 

presence of epithelioid granulomas affecting the piloseba-

ceous units, with or without caseous necrosis [1].

Information about dermoscopy of acne agninata comes 

from observations made in fair skin, and typical findings in-

clude follicular plugs surrounded by orange or yellow-orange 

areas, corresponding to follicular hyperkeratosis and perifollic-

ular dermal granulomas, respectively [2]. Despite a difference 

in terms of shade of the granulomatous structures (orange in 

fair skin vs yellow-orange in dark skin), due to the diverse back-

ground color, our cases underline that the dermoscopic pattern 

of acne agminata is similar, regardless of skin phototype.



2 Image Letter | Dermatol Pract Concept. 2025;15(3):5568

2. Errichetti E, Stinco G. Dermatoscopy of Granulomatous Disor-

ders. Dermatol Clin. 2018;36(4):369-375. DOI:10.1016/j.det 

.2018.05.004. PMID: 30201146.

References

1. Errichetti E, Lallas A. Granulomatous non-infectious disorders. 

In: Lallas A, Errichetti E, Ioannides D, editors. Dermoscopy 

in General Dermatology. 1st ed. Boca Raton, FL: CRC. 2018: 

56–64. DOI: 10.1201/9781315201733.

Figure 1. (A) Clinical examination of the fair-skinned patient displays erythematous papules on the nasolabial folds and periorbital area; 

(C) the dark-skinned patient exhibits red-to-brown papules on the nose and cheeks. (B) Dermoscopic examination reveals follicular white 

plugs surrounded by orange structureless areas (arrow) in the fair-skinned patient and (D) yellow-orange structureless areas (arrow) in 

the dark-skinned patient. (E) Histopathological analysis demonstrates dermal granulomas localized around the pilosebaceous units and 

follicular hyperkeratosis.