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We note the helpful letter from Held and Grossman. In our patients the diagnosis was made on the typical features of acne, namely comedones, papules, and pustules. We accept the fact that the patient described by Held and Grossman had a papular eruption with no other clinical features to suggest a specific diagnosis. A biopsy might thus have been essential there. While we accept that a biopsy may have added to the diagnosis in our patients, both our patients had an excellent response to therapy, and close-up views of the eruptions were submitted (Figure) that are very convincing, but we were limited by the number of pictures we were permitted to publish.
Adriaans B, Vivier AD. Acne in an Irradiated Area-Reply. Arch Dermatol. 1990;126(1):120. doi:10.1001/archderm.1990.01670250126024