What is Pyoderma Faciale?     What is Acne?     What is Rosacea?     About Me


What is pyoderma faciale?

Pyo means "pus." Derma means "skin." Faciale means "face."

I give you PUS FACE. People have been called worse.


Some also call it rosacea fulminans. Rosacea means "rose-colored" and fulminans means "developing suddenly."

I go with pyoderma faciale because it's more to the point. You don't agree? Not to worry. As shown below, professionals' opinions vary as well.

Here are some quotes, all published recently, that might be helpful. Let's keep in mind that PF is a rare thing, so articles that got it spot on seem just as rare.


Acne and Rosacea. Epidemiology, Diagnosis and Treatment: David J. Goldberg, 2012:

Pyoderma faciale is a condition previously considered a variant of rosacea. It has now been reclassified as a separate diagnostic entity.

The following article is the best I could find in that it is the most detailed. It is much longer than what you can see here and it includes a serious list of references. Here you can buy the book from Springer. And this is Dr Zeichner's page at Mt. Sinai.

Acneiform Eruptions in Dermatology - A Differential Diagnosis. Joshua A. Zeichner, M.D. (Editor). Springer, New York, 2014
Cristina Caridi and Joshua A. Zeichner, Department of Dermatology, Mt. Sinai School of Medicine, New York, NY

Rosacea fulminans is a rare dermatosis characterized by the sudden onset of coalescing nodules and draining sinuses on the face, typically affecting young women. First reported in 1940 by the name pyoderma faciale, it was thought to be an infiltrative pyoderma, possibly caused by tuberculosis, despite being unable to identify a cause.

It was not until 1992 that it was suggested that the condition was a form of rosacea, as all patients also experienced flushing and blushing along with the rapid and volatile onset. The term rosacea fulminans was then proposed.

Despite research, a bacterial infection has not been shown to play a pathogenic role, further evidence that the condition is not a pyoderma, but rather a severe variant of rosacea.

The pathophysiology of rosacea fulminans is unknown. Hyperactivity of the innate immune system, severe emotional stress, hormonal changes (including those during pregnancy), and an association with inflammatory bowel disease have all been suggested.

While extremely rare, rosacea fulminans is also assumed to be highly underreported. Approximately 80 cases have been published since the 1940s. It occurs almost exclusively in healthy females in the second to third decades, but ages range from the teens into the 50s.

There is no associated history with acne vulgaris, but many patients may have an underlying diagnosis of rosacea.

Rosacea fulminans is characterized by a sudden and explosive onset of large indurated erythematous plaques, nodules, papules, pustules, and draining sinuses restricted to the face. Patients generally have previously unblemished skin.

The most severely affected areas of the face include the forehead, nasal bridge, cheeks, and chin. Comedones are characteristically absent and the trunk is spared. Large abscesses may be interconnected through sinus tracts that discharge copious amounts of pus.

No true prodrome exists prior to the onset of the disease.

Patients are otherwise healthy, though some experience fatigue, discomfort, or general malaise. Because of the particularly ferocious nature of the disease, patients may become depressed, anxious, and isolated because of their appearance. Scarring is common and expected and can range from minimal damage to keloids.

Skin biopsy reveals evidence of inflammation, with massive neutrophil infiltration in early stages and epithelioid cell granulomas in older lesions. Bacterial pathogens have not been consistently recovered, and most bacteria identified are commensal skin flora.

If untreated, rosacea fulminans generally resolves after approximately 1 year, although aggressive therapy is usually given to avoid the development of permanent scars.

Rosacea fulminans is a rapidly occurring, severe facial dermatosis thought to be an extreme variant of rosacea. It results in significant scarring, both physically and emotionally. Early diagnosis with prompt treatment (usually with oral isotretinoin) is important to minimize long-term sequelae.

This one says that pyoderma faciale is an acne variant.

ABC of Dermatology - Sixth Edition, edited by Rachael Morris-Jones, 2014 John Wiley & Sons, Hoboken, NJ

Another variant is pyoderma faciale, which produces erythematous and necrotic lesions and occurs mainly in adult women.

Interesting potential connection with erythema nodosum here. EN and PF seem to have some similarities.

Treatment of Skin Disease - Comprehensive Therapeutic Strategies - Fourth Edition, Mark G. Lebwohl and a ton of other people, copyright 2014 Elsevier Saunders

Page 229:

Erythema nodosum (EN) [NOT PYODERMA FACIALE] is a septal panniculitis that presents as tender, erythematous nodules and plaques located primarily on the extensor surfaces of the lower extremities. There is a predilection for females. Numerous etiologies have been implicated, including chronic inflammatory states, infections, reactions to medications, and, rarely, malignancies. There is a tendency towards spontaneous regression, which usually occurs within 6 months after the onset of the first lesions.


Patients with certain diseases that are characterized by chronic inflammation may develop EN. The most common disease is sarcoidosis but inflammatory bowel disease (Crohn disease and ulcerative colitis), Behçet syndrome, Sweet syndrome, pyoderma faciale, and chronic abscesses have been associated.

Page 691:


Rosacea fulminans (pyoderma faciale) is a very severe facial eruption of sudden onset with prominent pustulation and abscess formation. In addition to conventional treatment modalities for rosacea, a short course of systemic steroids is often indicated to reduce the acute inflammation. Isotretinoin seems to be useful in this condition.

Treatment of rosacea fulminans with isotretinoin and topical alclometasone dipropionate.
Veraldi S, Scarabelli G, Rizzitelli G, Caputo R. Eur J Dermatol 1996; 6: 94–6.

Five cases were treated successfully with this combination. Alclometasone dipropionate cream (a moderate-potency corticosteroid) was applied twice daily for 10 days then daily for 10 days. The initial dose of isotretinoin was 0.5 mg/kg/day for 1 month followed by 0.7 mg/kg/day for 3  months. Combined cyproterone acetate/ethinylestradiol was used as a contraceptive. Marked improvement was observed after a month and complete resolution after 4 months.

The following book is on Amazon.

Acne: Diagnosis and Management - William J. Cunliffe, Harold P.M. Gollnick 2001:

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 superficial 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. The paranasal, malar [cheek bones] regions and chin are almost always involved.

Pyoderma faciale can be an emotionally, socially and physically devastating condition and many sufferers have to discontinue their work and social obligations for as long as one year because of their skin condition.

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 medial problem such as gastrointestinal bleeding or depression) before the onset of lesions.

Most patients had multiple cultures taken, which in 26 per cent were totally negative. Thirty-six per cent had growth of only Staphylococus epidermidis. Of the remaining most showed growth of multiple organism, most often Staph. epidermidis, Corynebacterium species and P. acnes. Staphylococcus aureus was isolated in 10 per cent. No patient had significant Gram-negative infection.

In the paper by Massa and Su, remission was defined as return of facial complexion to the predisease state or clearing with only occasional development of new lesions. This was achieved in 62 per cent of patients by six months and in 88 per cent by one year.


Healing Adult Acne - Your Guide to Clear Skin & Self-Confidence, Richard G. Fried, 2005:

Both pyoderma faciale and acne fulminans are rare forms of extremely inflammatory acne.

With pyoderma faciale and acne fulminans, red, tender, painful, and even bleeding acne lesions make a sudden appearance. It is almost as though you go to sleep without acne and wake up the next morning with severe acne. The acne sometimes literally appears overnight.

Pyoderma faciale usually occurs in females, while acne fulminans usually occurs in males. The cause of these conditions is not fully understood, but both are considered severe inflammatory reactions, extreme examples of the immune system overreactivity discussed earlier in this chapter.

Pyoderma faciale and acne fulminans are more than skin-deep. Besides the extremely painful skin lesions, symptoms such as joint pains, muscle pains, and excessive fatigue are often present at well. Evidence that both these conditions are true full-body reactions is found when medical tests are performed. Abnormalities in blood tests are sometimes found, and in rare instances, there are even abnormal X-ray studies showing inflammation in the bones and joints.

Pyoderma faciale and acne fulminans are true dermatologic emergencies.

Hurwitz Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence by Amy S. Paller, Anthony J. Mancini, published 2011 by Saunders; 4 edition:

Pyoderma Faciale is a relatively rare condition that presents with the sudden onset of coalescent fluctuant cysts, nodules, and papulonodules with draining sinuses. It is usually confined to the face and occurs exclusively in post-adolescent females. Pyoderma faciale seems to represent a severe form of rosacea, and isotretinoin is the most effective therapy, especially when used in combination with corticosteroids. Most patients develop scarring as a sequela.

Severe Skin Diseases in Children: Beyond Topical Therapy by Wynnis L. Tom, 2014 Springer:

Pyoderma Faciale is considered to be a variant of rosacea by many and is sometimes referred to as rosacea fulminans to reflect its analogous presentation to acne fulminans. It represents an extreme manifestation of the inflammatory component of rosacea and occurs almost exclusively in females.

PF presents on the faces of young women with the sudden onset of deep, coalescing nodules; draining sinuses with tract formation; and inflammatory cysts. Localization to the chin, nose, cheeks, forehead, and temples is common, and a background of blushing and flushing is required.

Systemic signs and symptoms may be present and include fever, leukocytosis, and elevated erythrocyte sedimentation rate. Due to the rapid onset and inflammatory nature, patients require systemic therapy for several months.

Dermatology By Otto Braun-Falco, 1991 Springer:

Rosacea Fulminans - Synonym Pyoderma faciale (O'Leary and Kierland 1940)

This illness typically appears suddenly on the midface of young women; we interpret it as the maximum variant of rosacea and have thus named it rosacea fulminans in analogy to acne fulminans.

We believe it is identical to pyoderma faciale. Patients typically have almost an eruption of draining erythematous plaques with pustules involving their cheeks, chin and forehead. We have seen such patients later develop typical rosacea.

The main differential diagnosis is acne fulminans, which occurs almost exclusively in young men who usually have some other stigmata of acne. Androgen-producing tumors, bromoderma and iododerma must be excluded, but tend to have a slower onset.



Acne or pyoderma faciale, the result is the same: permanent skin damage. 

As promised, I'm not showing any revolting photos of faces. But I found this image on this site (which does show you real face images)

Icepick Scars, Rolling Scars, Boxcar Scars
(In addition, you do have of course the remnants of your abscess pockets, they won't go anywhere. Although they do shrink a bit, praise Jesus.)

I have no connections to that site. This is just to illustrate that the scars caused by PF are similar to the ones caused by regular acne, and therefore regular acne scar treatment might be something worth looking into.




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