Pyoderma faciale was introduced as a distinctive entity by O’Leary and Kierland,’ while an excellent report of twenty-nine cases has been provided by Massa and Su.

The disease affects only female patients, mainly in the 20-30 year age group, although two over the age of 40 years have been observed. Pyoderma faciale is characterized by the sudden onset of deep and superfi-cial cystic lesions of the face with interconnecting sinus tracts; there is a conspicuous lack of comedones.

A reddish to cyanotic erythema of the face and local oedema are common. The affected area is sharply demarcated from normal skin and tends to be localized in the central part of the face.

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A previous history of acne was elicited in less than 50 per cent of the patients studied.35 Most females had no medical illnesses but a small number had prior medical problems, the significance of which is uncertain: rheumatoid arthritis, ulcerative colitis and thyroid dis-ease.

Twenty-eight per cent of patients recalled a traumatic emotional experience (for example, the death of a loved one, divorce, severe family turmoil, or a major medical problem such as gastrointestinal bleeding or depression) before the onset of lesions.

An elevated leucocyte count and sedimentation rate was found, not surprisingly, in some of these pyoderma faciale patients. Positive antinuclear antibodies and rheumatoid factors were seen in fewer than 10 per cent of patients, the meaning of which is unclear.

Treatment
Since pyoderma faciale is so acutely disfiguring hospitalization is required for about 60 per cent of patients, for up to six weeks. Most patients have been treated with high-dose oral antibiotics, in particular, with tetracycline i I g day) and, to a lesser extent, with minocycline.

A previous history of acne was elicited in less than 50 per cent of the patients studied.35 Most females had no medical illnesses but a small number had prior medical problems, the significance of which is uncertain: rheumatoid arthritis, ulcerative colitis and thyroid dis-ease. Twenty-eight per cent of patients recalled a traumatic emotional experience (for example, the death of a loved one, divorce, severe family turmoil, or a major medical problem such as gastrointestinal bleed-ing or depression) before the onset of lesions. An elevated leucocyte count and sedimentation rate was found, not surprisingly, in some of these pyoderma faciale patients. Positive antinuclear antibodies and rheumatoid factors were seen in fewer than 10 per cent of patients, the meaning of which is unclear.