To the Editor.—
I believe that we owe Dr Kligman and his colleagues a debt for reemphasizing the multifactoral etiologic panorama that the clinician calls acne.1,2 His team has stressed the comedogenicity of chemicals and cosmetics.2 They noted the aggravating but noncomedogenic quality of shearing stress based on laboratory observations, disputing earlier clinical observations.3,4 They prefer the "comedogenic potential" of soap to the pathogenetic shearing stress of traumatic friction.5There is another rarer variety that I have termed "acne traumatica allergica," although I will concede that the commonest variety may not be "allergic." In this entity, lesions of acne minor are aggravated by rubbing the skin in response to both immunologic and nonimmunologic stimuli. After consuming tomatoes for example, some patients itch and rub. Their skin may pinken or even urticate. Certain atopics blanch. After this integumentary massage, papulopustular and even cystic lesions occur in
Yaffee HS. Acne Traumatica Allergica. Arch Dermatol. 1976;112(5):729. doi:10.1001/archderm.1976.01630290071018
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