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PURPOSE Acne agminata has only been rarely reported in the ocular adnexa. This study was undertaken to identify histopathological, clinical, and management features of this disorder. METHODS A computerized database was utilized to identify cases of ocular adnexal acne agminata. Via chart review and light microscopy, clinical and histopathologic aspects of this dermatosis were collected, and statistical analyses were performed. RESULTS Twelve cases (5 males, 7 females, mean age = 50.5 years) of clinically and histopathologically confirmed ocular adnexal acne agminata were identified. The main variant of granuloma was sarcoidal in 6 cases (50%) and tuberculoid in 5 cases (41.7%), although 9 specimens (75%) displayed greater than 1 variant of granuloma. In addition, specimens demonstrated varying degrees of fibrosis (8 cases, 66.7%), necrosis (6 cases, 50%), spongiosis (5 cases, 41.7%), and perifollicular inflammation (6 cases, 50%). All specimens showed signs of lymphstasis-lymphangiectasis. At a minimum of 6-month postprocedure interval, all patients experienced complete relief of their symptoms and did not experience recurrence. CONCLUSIONS This study represents the largest cohort of ocular adnexal acne agminata, and revealed a spectrum of granulomatous subtypes, including coexistence of different granuloma subtypes within the same specimen. Lymphangiectases is a hallmark of this disorder, and varying features of tissue reaction are typical features of acne agminata. All of these cases were successfully cured by surgical resection of lesions without recurrence at last follow-up, and this modality should be considered the standard of care in the management of this problem.

Acne agminata (AA) and lupus miliaris disseminatus faciei (LMDF) have been used to describe very similar clinical conditions and it is now generally accepted that they are synonymous. The cause of these disorders has not been determined. Clinically the disease presents with often agminated redbrown to yellow papules which occasionally become pustular. Microscopically, superficial granulomatous inflammation with perifollicular caseating granulomas is the hallmark. Axillary involvement with LMDF has rarely been reported; in this area AA has been the preferred term. When only the axillae are affected, it may be difficult to distinguish acne agminata from other granulomatous diseases, especially from granulomas caused by antiperspirants containing aluminumzirconium complexes. We describe a 36-year-old woman with axillary acne agminata.

Acne agminata and lupus miliaris disseminatus faciei (LMDF) have been used to describe very similar clinical conditions and it is now generally accepted that they are synonymous.The cause of these disorders has not been determined. Clinically the disease presents with often agminated red-brown to yellow papules which occasionally become pustular. Microscopically, superficial granulomatous inflammation with perifollicular caseating granulomas with caseation are the hallmarks. Axillary involvement with LMDF has rarely been reported; in this area AA has been the preferred term. When only the axillae are affected, it may be difficult to distinguish acne agminata from other granulomatous diseases, especially from granulomas caused by antiperspirants containing aluminium-zirconium complexes. We describe a 36-year-old women with axillary acne agminata.