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Acne Mechanica

Acne Mechanica refers to an acneifom eruption when mechanical forces are exerted over the skin. This can be in the form of pressure, occlusion, squeezing, rubbing, friction or stretching. Acne mechanica is more common in individuals with pre-existing tendencies to developing acne, and may even worsen mild acne to become inflammatory acne or even cystic acne

How Do I Know I Have Acne Mechanica?

Location! The characteristic pattern of pre-adolescent acne is mainly confined to the forehead. During adolescent period, acne lesions are commonly found in the T-Zone area (forehead/cheeks/Chin), and may involve back and chest skin in more severe cases. Adult onset acne which is mainly hormonally driven commonly affects the skin around the jawline, upper neck and chin. We call this the U-shape pattern in adult acne cases.

The distribution of acne lesions in acne mechanica can have the most unusual distributions. A violin player may experience predominant acne only on one side of the neck, whereas a young helmet-wearing soldier may find that he has stubborn acne around his chin strap area. Another common example would be a student that unconsciously lays his hands over his chin and cheeks, and does so repeatedly during the course of study, and perhaps more so before an exam!

Athletes that engage in sports where they need to don shoulder pads may find acne sitting there. A bus driver who spends hours with his back against the chair, may develop moderately-severe back and buttock acne. Another common area for acne mechanica to take place would be underneath orthopaedic casts after an injury. This can affect the upper or lower limbs or even truncal areas.

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How Do I Treat Acne Mechanica?

It may seem obvious. Stop the offending mechanical forces that may be perpetuating the acne. However, in cases where acneiform lesions persists despite efforts to reduce the mechanical stress on the skin, it would be advisable to see a doctor for further assessment and management. This is because individuals who develop acne mechanica are more acne prone, and delays in treatment may lead to the worsening of the acne and cause permanent acne scars.

Nowadays, acne vulgaris is a treatable skin condition. Acne treatments take into account the severity of the acne, the predominant acne lesion type, duration and the distribution of  your acne. While milder forms of acne may respond to topical treatments, moderate to severe forms of acne may be better treated with oral medications such as an antibiotic or even oral isotretinoin. 

References:

  1. Brun P, Baran R: A special type of mechanical acne: fiddler’s neck dermatitis. Ann Dermatol Venereol 1984;111:241-245.
  2. Otto H, Mils Jr, Albert kligman. Acne Mechanica. Arch Dermatol. 1975;111(4):481-483