acne miliaris necrotica acne miliaris necrotica acne miliaris necrotica is a severe form of folliculitis of typically the scalp. it presents as multiple fluid-filled bumps, sometimes occurring as solitary lesions that are usually very itchy. shortly after appearing, the bumps burst and dry up. there may be scarring. not to be confused with acne necrotica. acne miliaris necroticaother namesacne varioliformisspecialtydermatologysymptomsitchy fluid-filled bumps on typically scalpcomplicationsscarringcausesinflammatory reaction to part of the hair follicle and s. aureusdiagnostic methodvisualisation, culturetreatmentantibioticsmedicationdoxycycline causes the cause may be a result of an inflammatory reaction to part of the hair follicle and s. aureus. diagnosis diagnosis is by visualisation and culture of the lesions. treatment there are multiple medications that are able to treat acne varioliformis. topical clindamycin 1% lotion or benzoyl peroxide/clindamycin gel erythromycin 2% gel 1% hydrocortisone cream systemic doxycycline 50 mg twice daily isotretinoin 0.5 mg/kg daily epidemiology the condition affects middle aged and elderly individuals. history the condition was first described by sabouraud in 1928.