SYSTEMIC METHYLPREDNISOLONE–ASSOCIATED ACNEIFORM ERUPTION MIMICKING MALASSEZIA FOLLICULITIS IN AN ADOLESCENT: A CASE REPORT

Drug-induced acneiform eruptions have been well-known side effects of systemic corticosteroids, usually presenting as monomorphic inflamed papules and pustules without comedones. Similar to Malassezia folliculitis, their presentation can make their diagnosis difficult especially among teenagers taking systemic corticosteroids for long periods of time.A 14-year-old boy presented with progressive papulopustular lesions that first affected his back after approximately two months of therapy with oral methylprednisolone for traumatic optic nerve edema. In total, there were numerous discrete, monomorphic, and predominantly folliculocentric red papules and pustules involving his face, neck, chest, shoulders, back, and proximal upper limbs. No comedones, nodules, and cysts were present, and he experienced minimal pruritus. In spite of the morphology and distribution being suggestive of Malassezia folliculitis, the direct examination under potassium hydroxide preparation of lesional material showed no yeast or hyphal forms. Based on the temporal relationship with high doses of methylprednisolone, morphology, minimal pruritus, negative direct microscopy, and lack of an alternate well-established etiology, a steroid-induced acneiform eruption was diagnosed. Methylprednisolone was decreased based on an ophthalmologist-directed taper regimen, along with oral erythromycin, cetirizine, and topical fusidic acid. After one week of treatment, pain, purulent drainage, and inflammation were improved without development of new lesions. With a Naranjo score of 6, it was probable. Systemic corticosteroid-induced acneiform eruption needs to be taken into account in cases where the patient is suffering from a monomorphic papulopustular eruption while on treatment. Since there is an extensive similarity in both the diseases with respect to the clinical presentation, diagnosis can only be done by considering all aspects together.