A young woman with fluctuant facial pustules

Over a one-month period, a 34-year-old woman developed multiple facial pustules associated with tender red nodules that were fluctuant (Figure 1). These were located particularly over the forehead, nasolabial folds and chin. Her chest and back were spared. There were no systemic symptoms. The patient had a prior history of flushing. Close examination revealed no comedones. A skin biopsy showed a perifollicular abscess with numerous neutrophils (Figure 2). Bacterial cultures failed to reveal pathogenic bacteria.