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PubMedDate not supplied

[Akne-Mycyna in the local treatment of acne].

Akne-Mycyna, a new preparation for external treatment of acne containing 1% erythromycin, was used in 30 cases of acne: 12 cases of papulo-pustolous acne, 13 with pustulous acne, 5 with acne conglobata. The age of the patients ranged from 16 to 27 years, the mean duration of acne was 3.5 years. Selected lesions were smeared with Akne-Mycyna twice daily, mostly on one side of the face; symmetrical lesions were treated by conventional external methods. In the light of the study it is concluded that Akne-Mycyna is a very effective preparation for external treatment of papulo-pustulous acne and in milder cases of pustulous acne, with the duration of treatment at least 3 weeks. In deep forms of acne, particularly acne conglobata, Akne-Mycyna may be a valuable supplementation of systemic treatment.

Acne Vulgaris↗
PubMed1987

[Acne and osteoarticular manifestations].

Certain severe forms of acne vulgaris may be accompanied by disorders of the locomotor system. Fulminant acne is manifest as an acute disorder with an alteration of general health and with fever, the onset of painful, necrotic skin lesions, myalgia and arthralgia with arthritis of one or more joints. Acne conglobata, a chronic disorder, is defined by the presence of comedones in sebaceous gland ducts and its progression to form nodules and pustules, leaving indelible scars. Osteoarticular involvement which occurs during the course of acne conglobata, and whose incidence is difficult to determine, is characterized by the frequent presence of sacroiliac inflammation. However, these two forms of acne are often confused and the authors outline differences between them. A more accurate identification of cutaneous manifestations would perhaps provide an eventual classification of "rheumatic disturbances of acne" whose nosological category has not yet been determined.

Acne Vulgaris↗
PubMedDate not supplied

Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne.

BACKGROUND/AIMS: The primary aim of the study was to establish the clinical efficacy and safety of a combined treatment consisting of topical 20% azelaic acid (AA) cream and the oral antibiotic minocycline in the therapy of severe inflammatory acne (nodular papulopustular acne and acne conglobata) in a comparison with oral isotretinoin therapy. The secondary aim was to establish the value of AA cream as maintenance therapy in the prevention of recurrent acne. METHODS: This open-label but randomised study involved 85 patients with nodular papulopustular acne or acne conglobata (Leeds grading scale > 4) who were treated for 6 months. In an immediately subsequent 3-month second phase, eligible patients from the initial combination group used the AA cream as maintenance therapy, while the eligible patients from the isotretinoin group served as untreated control. RESULTS: A 6-month course of treatment with topical 20% AA cream plus oral minocycline in 50 patients proved to be effective in nodular forms of acne (median reduction of facial comedones: 70%; of papules and pustules: 88%; of deep inflammatory acne lesions: 100%). Overall, the combined treatment was not quite as effective as treatment with oral isotretinoin (35 patients; reduction of comedones: 83%; of papules and pustules: 97%; of deep inflammatory acne lesions: 100%). In the 3-month maintenance therapy phase, about half of the patients who received AA monotherapy maintained the very good facial result achieved by the end of phase I. A similar rate was found in the patients of the isotretinoin group, who received no further active acne treatment. In the other 50% of patients, differences existed between the groups as regards the degree of deterioration: Marked deterioration occurred more frequently under AA treatment, while only slight deterioration was more frequent in the isotretinoin group. The combination was tolerated much better than isotretinoin. The incidence of local side effects observed under the combination of AA and minocycline (36.5%, mainly transient burning and itching of mild or moderate intensity) was considerably lower than that seen with isotretinoin (65.7%). The rate of local side effects of marked intensity observed under the combination, i.e. 6%, was well within the range of 5-10% previously reported for AA. The incidence of systemic side effects was lower (8%, mainly gastrointestinal symptoms) under the combined therapy than under isotretinoin (14.3%). CONCLUSION: The combination of topical 20% AA cream and oral minocycline is an highly effective treatment in severe forms of acne. It is better tolerated and associated with fewer risks than oral isotretinoin - in particular, there is no risk of teratogenicity. The combination can be regarded as a valuable alternative in patients for whom isotretinoin is not indicated, who do not wish to use or can not tolerate isotretinoin therapy and particularly in female acne patients of child-bearing potential. Topical 20% AA cream can be used successfully as maintenance therapy to prolong the recurrence-free interval.

Acne Vulgaris↗
PubMed1996

Acne: a potential side effect of cyclosporine A therapy.

A renal transplant recipient who developed severe acne 6 months after transplantation is described. Maintenance immunosuppression consisted of cyclosporine A (CsA), azathioprine and prednisone. Tapering the prednisone dose to as low as 5 mg/day, in addition to topical tetracycline, Retin-A cream, and systemic antimicrobial therapy failed to control the progression of the skin lesions. Despite therapy with isotretinoin (Accutane), the lesions continued to progress with nodulocystic transformation (acne conglobata) and isotretinoin was discontinued after 4 months. However, the condition continued to worsen with the development of a systemic illness with daily fever, diaphoresis, and depression. High fever (103 degrees F) with shaking chills prompted hospitalization. Withdrawal of CsA resulted in rapid and continuous improvement of the skin lesions. After 12 months of follow-up, the lesions significantly resolved except for residual areas of scarring. No episodes of acute allograft rejection occurred. In conclusion, we suggest that CsA therapy may be associated with the development of acne. Nodulocystic transformation (acne conglobata) may occur despite the use of isotretinoin. Finally, withdrawal of CsA may lead to resolution of the skin disease and should, therefore, be considered as a therapeutic option for severe and treatment-resistant cases.

Acne Vulgaris↗
PubMed1978

Dapsone-induced jaundice.

Enthusiasm in the use of dapsome for acne conglobata and other severe acne has created an increase in the use of this drug by dermatologists. We describe three patients in whom jaundice developed during dapsome therapy of 3 to 36 weeks' duration. Jaundice was due to cholestasis in two cases and to hemolysis in the third. These significant side effects call for careful observation by the physician if dapsone is to be used with safety.

Adolescent↗
PubMedDate not supplied

[Acute acne fulminans et conglobata after the end of high-dose testosterone therapy for hereditary tall stature].

We report on a 13.2 years old boy who was treated for tall stature (expected target height of 204.8 +/- 5.4 cm) with high dose of testosterone. Therapy for height reduction was started with testosterone injections (250 mg Testoviron Depot i.m.) once a week. There occurred no side effects during 6 months of treatment. Maximal blood testosterone concentration was 1209 ng/dl (norm: 300-1000 ng/dl). After six months height reduction was successful with a final height of 192.7 cm. Four weeks after cessation of therapy a severe acne conglobata et fulminans appeared in the face, the back and the breast lacking any familial predisposition for acne or other skin diseases. The exacerbation was accompanied by decreased endurance, nausea and indisposition. Leucocytosis with left shift, elevation of blood sedimentation rate and C-reactive protein in addition with an increase of immunglobulin G (IgG) were detectable. At that time testosterone concentration was 192 ng/dl. Systemic treatment was started with isoretretinoin therapy (retinoid 13-cis retinacid (Roaccutan) 0.3 mg/kg), 8 mg methylprednisolon (Urbason) and cefaclor (Panoral). Local therapy included external disinfectants. After 4 months of treatment infection parameters disappeared and the acne healed with visible skin defects and severe scars. This is the first case report on acne conglobata et fulminans that appeared after cessation of testosterone therapy. High testosterone treatment seems to trigger the outbreak of sex hormone related skin disorders such as acne fulminans. It can be presumed that testosterone leads to longer lasting induction of androgen receptors resulting in acne fulminans even four weeks after treatment. Patients asking for hormonal height reduction should be aware of this rare but serious side effect.

Acne Vulgaris↗
PubMed2001

[Acne inversa: a dapsone-sensitive dermatosis].

Acne inversa is a chronic disease with a major impact on the quality of life. Therapeutic options were long restricted to local disinfectants and systemic antibiotics, as well as repeated incision and drainage which produce only short term benefits. Retinoids, antiandrogens and radiation therapy are only partially successful. The best approach appears to be surgical removal of the entire apocrine sweat gland apparatus. Dapsone is used in dermatology to treat inflammatory dermatoses such as dermatitis herpetiformis and pyoderma gangrenosum, and was formerly the treatment of choice for acne conglobata. We report its successful use in acne inversa. Five female patients aged 23-40 years with acne inversa for a mean of 9.6 years were included. All patients showed an almost complete resolution of their symptoms within 2-4 weeks. All patients rated the treatment results with dapsone as good or very good. The treatment was well tolerated and no important side effects occurred. Because of its lack of teratogenicity, dapsone may be the most favorable treatment option in young women with acne inversa.

Acne Vulgaris↗
PubMed2006

[Recurrence in patients diagnosed with acne treated by isotretinoin and other methods].

Common acne is the most frequently diagnosed dermatosis at the age of adolescence. It may lead to psychic disturbances and/or even depression as a result of its distinctly visible localization, very long-lasting symptoms, in sequela numerous deforming scars or vicious cicatrices. The objective of the present paper is to assess recurrences after the treatment of severe acne forms in patients treated in the Department of Dermatology in the years 1991-2000, with administration of various medications applied locally and/or generally. The evaluation of treatment results determined the highest, statistically significant difference between the patients subjected to isotretinoin-supported treatment process and the locally cured patients. In the group of locally treated patients the rate of the acne symptoms recurrence could be observed more often. In the remaining groups of patients, no statistically significant differences were reported. A little higher acne symptoms recurrence rate is apparent in the group of patients locally treated, as compared with that subjected to antibiotics-supported therapy. A statistically significant relationship between the therapy duration with the application of individual methods and the recurrence of illness has not been proven as yet. The value of p = 0,5245 proved that there existed no relationship between the diagnosis and a period of time elapsed--at the end of therapy--since the recurrence of acne disorders has been observed. The longest period of remission lasted when inversed acne had been recognized. Recurrence of the disease was observed the most rapidly in patients affected with acne conglobata. When examining the relationship between the duration of acne symptoms recurrence vs. treatment process, statistically significant differences amongst the individual applied methods were recorded. In the group A, recurrence of illness occurred at a higher rate. A statistically significant relationship between the recurrence of signs and symptoms and the initial diagnosis was excluded. A higher percentage of recurrence in the groups I, II and III has been reported as compared with group V. There is a certain relationship between the patient's age and the recurrence of the disease. It mainly referred to the elderly. Statistical analysis has proved that there existed significant relationship between the recurrence of the disease analysed and the patients' sex. A little higher rate of illness occurrence can be observed in a female group. The study revealed that recurrences in group of patients treated by locally active preparations were observed usually 6 months after the end of therapy.

Acne Vulgaris↗
PubMed1994

[Dermatology meeting of Paris. 7-10 December 1994. Abstracts].

In 1994 acne should be a very treatable disorder. However there are a significant number of patients who do not respond as well to therapy as they ought. Compliance is an important reason for poor response. Inappropriate therapy is another common reason. An increasing problem are patients with resistance of P. acnes to commonly used antibiotics; 39% of our patients have such resistance. Within this sub-group the commonest antibiotics causing problems are Erythromycin and Clindamycin (69%). Resistance is seen in 20% of such subjects to Tetracycline and Vibramycin and resistance to Trimethoprim is 12%. Multiple resistance is 14%. This is an increasing problem and unless attention is given to this problem by the year 2,000 we may have very few safe and successful antibiotics. Minocycline is rarely associated with resistance. Some patients have no resistance and may have a high sebum excretion; this will dilute what otherwise could be effective therapy. Such patients ought to be given high dose antibiotics such as Minocycline 200 mgs per day, plus appropriate topical therapy. Dianette plus 50- 100 mg cyproterone remains an alternative therapy in females. Some patients will fail to respond with these regimes and require Isotretinoin. Patients who require oral Isotretinoin are those with non-responding moderate acne, patients who scar, plus patients with unusual but specific problems. These include Acne Fulminans, Rosacea Fulminans, Acne Conglobata, Gram-negative folliculitis, Gross Seborrhoea, Dysmorphophobia, Mature Acne and Aperts Syndrome. The choice of dose varies, often according to personal experience and cost. Most physicians prescribe 0.5-1.0 mg/day for 4 months. Fifteen percent require 5-12 months therapy. Frequent reasons for prolonged therapy are macrocomedones and polycystic ovary syndrome. Relapse post therapy occurs in 30%; relapse after 3 years is unusual. Repeat doses can be given. The results are predictive and successful. The treatment of certain troublesome side effects also will be discussed as will the use of Isotretinoin in systemic disease. Isotretinoin orally is so effective that it ought to be given sooner rather than later to minimise scarring about which still only a little can be done to help the patient.

Animals↗
PubMedDate not supplied

[Acne today. What's new?].

WELL-CONDUCTED TREATMENT: Acne is a common condition in adolescents and requires careful management both in terms of therapeutic care and psychological support. Treatment is long and requires strict compliance. A well-conducted treatment can be expected to provide major improvement in most patients. LOCAL CARE: Local care is often sufficient for retentional or discretely inflammatory acne. A retinoid and/or a benzoyl peroxide can be associated with a local antibiotic. SEVERE FORMS: An oral antibiotic regimen for at least 3 months is proposed in association with the local treatment (retinoid, benzoyl peroxide, local antibiotic) in case of severe acne. ISOTRETINOIN: In case of unsuccessful treatment for nodular or conglobata acne, isotretinoin can be proposed in an oral preparation. This highly teratogenic drug must not be prescribed for women of reproductive age unless a well proven contraception has been instituted for more than 1 month and maintained for the entire duration of the treatment and 1 month after discontinuation. The patient must be informed of the risk in case of pregnancy and consent to regular monitoring of beta hCG less than 3 days before treatment onset, every 2 months during treatment and 5 weeks after treatment withdrawal).

Acne Vulgaris↗
PubMed1982

Steatocystoma multiplex: anatomic reevaluation, electron microscopy, and autoradiography.

Histologic and electron-microscopic features of steatocystoma multiplex were investigated. Specimens from 25 patients (8 females, 17 males) were serially cut and three-dimensional drawings constructed. Steatocystoma multiplex is a nevoid sebaceous duct and sebaceous gland tumor, originating from sebaceous follicles, but is not a dermoid tumor. One pilary unit continuously produces vellus hairs, which are trapped in the cystic cavity or in the pilary canal (trichostasis). Steatocystoma multiplex is connected to the epidermis by a straight or meandering epithelial cord, the remnant of the follicular infundibulum. This infundibulum is a more or less solid strand, often containing sebocytes or sebaceous lobulelike structures. A lumen, partly present in a few areas of the cord, is filled with cellular debris of keratinocytes, corneocytes, sebocytes, or trapped hairs. Steatocystoma multiplex has electron-microscopical features similar to the sebaceous duct and sebaceous glands of sebaceous follicles. The 3H-thymidine labeling index of the cyst wall with or without sebaceous acini is lower than in sebaceous follicles. Steatocystoma multiplex suppurativum, characterized by spontaneous rupture of the cyst, inflammation and scarring, mimics acne conglobata with hidradenitis-suppurativa-like lesions as seen in the acne triade or tetrade.

Adolescent↗
PubMedDate not supplied

Pathogenesis and treatment of acne in childhood.

Acne occurs more frequently in newborns and infants than one would gather from written accounts. Acne neonatorum tends to be overlooked because it is usually minor and transient. In contrast, acne infantum, which generally does not make its appearance until after 3 months of life, is more serious. Even acne conglobata may develop in infants. There are many other types of acne in childhood reflecting different pathogenetic mechanisms; included in this group are acne venenata infantum, steroid acne, hormonal disturbances, and toxic reactions.

Acne Vulgaris↗
PubMed1977

Acne fulminans: investigation of acute febrile ulcerative acne.

Eight cases of acne fulminans (acute febrile ulcerative acne) are compared with 13 previously reported cases. This rare disorder of male teenage patients is characterized by the sudden appearance of highly inflammatory, tender, ulcerative and crusted lesions on the back, chest, and face: it is one of the most scarring acute dermatologic disorders of young patients. At the onset of the disease, all patients showed febrile temperatures and marked leukocytosis; other systemic symptoms occurred with varying frequency. Polyarthralgia was noted in half of our series. Investigations of potential trigger mechanisms (eg, septisemia due to Corynebacterium acnes, immunologic defects, altered polymorphonuclear leukocyte function, Shwartzman phenomenon) did not yield any clues regarding the pathogenesis of this disease. Clinical and laboratory findings suggest that acne fulminans is not directly related to acne conglobata.

Acne Vulgaris↗
PubMed1984

Familial hidradenitis suppurativa: evidence in favour of single gene transmission.

The three English families in this report have a total of 21 members (16 females and five males) suffering from chronic hidradenitis suppurativa. In family A the condition is associated with acne conglobata and there is vertical transmission of the disorder through three generations. In the others there is no associated cystic acne, but all those affected had a history of acne vulgaris with comedone formation, and the condition has been confirmed in two generations. It is likely that a male in an earlier generation in family B suffered from the disease and affected sibs in family C were born to different fathers. The familial aggregation and number of affected subjects suggests a single gene disorder and the pattern of transmission is consistent with autosomal dominant inheritance. Males and females are affected in successive generations and there is the anticipated variation in clinical severity in those suffering from the condition.

Adolescent↗
PubMed1992

Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne.

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection. The association of cystic acne with PRP and their response to treatment are discussed.

Acne Vulgaris↗