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PubMed1998

Pyogenic granuloma-like lesions in a patient using topical tretinoin.

A 16-year-old male developed numerous pyogenic granuloma like-lesions across his neck, chest and back after 6 weeks isotretinoin therapy for cystic acne. The isotretinoin was ceased and he was commenced on oral steroids. After 6 weeks, the lesions were almost completely healed. However, due to worsening comedonal acne, the patient was commenced on topical tretinoin cream 0.05% twice daily to his chest. He was reviewed 2 weeks later and, surprisingly, 2 new pyogenic granuloma-like lesions had developed on his chest. These lesions persisted until the topical tretinoin was ceased 3 months later.

Acne Vulgaris↗
PubMed2006

Naevus comedonicus of the scalp.

We report the case of a 3-year-old boy with naevus comedonicus, characterized by confluent clusters of dilated follicular orifices plugged with keratinous material that resemble open comedones, located on the scalp.

Child, Preschool↗
PubMed2006

Development of sonic technology for the daily cleansing of the skin.

Even though many skin cleansing products are commercially available, the cleansing of the skin is dependent upon the user's diligence, compliance, and technique, which often results in inconsistent cleansing. When the skin is inadequately or excessively cleansed, the skin becomes compromised, sometimes leading to acute or chronic conditions that may require medical attention. A sonic skincare brush was developed to enhance and provide consistent skin cleansing while preventing the skin from becoming compromised. Utilizing a technology previously used to cleanse the oral cavity, the sonic skincare brush is optimized to work with the skin's own elasticity providing rapid oscillatory flexing of the infundibular opening. By oscillating at sonic speed the net result is the inelastic comedones become loosened and detached from the infundibular wall and are then cleared from the acroinfundibulum. Although additional clinical research into the various applications of sonic skin care technology is needed, utilization of sonic technology is now available for effectively and consistently cleansing the skin.

Humans↗
PubMed1979

Complications of implantation of synthetic fibers into scalps for "hair" replacement: experience with fourteen cases.

Fourteen cases of complications from implantation of acrylic fibers into scalps for correction of male-pattern baldness were studied. The complications were severe enough in all of them to force attempts to remove the fibers, many of which from the nature of their knotted insertion could not be extracted. Thus, immediate complications were encountered and serious, delayed, bad effects are anticipated. Among the early complications already observed are marked edema of the face; hemorrhagic oozing; microbial infection; foreign-body reactions; scarring; acneform comedones and pustules; pain, pruritus, and numbness; and loss of natural hair. Complications in the furture are likely to be progressive sclerosis from irretrievable fragments and knots of the artificial materials and conceivably malignant degeneration of tissues of the scalp. For all of these known and possible bad effects, implantation of present-day synthetic fibers into the scalp must be judged to be a dangerous practice that must be stopped at once.

Acrylonitrile↗
PubMed1997

The effect of glycolic acid on the treatment of acne in Asian skin.

BACKGROUND: Glycolic acid has become important and popular for treating acne. OBJECTIVE: To evaluate the efficacy and safety of serial glycolic acid peels with glycolic acid home care products on facial acne lesions and other associated skin problems. METHODS: We collected 40 Asian candidates with moderate to moderately severe acne. They were divided into two groups according to the degree of greasiness of their facial skin. The two groups' members were treated with four series of 35% and 50% glycolic acid peels, respectively. They also used 15% glycolic acid home care products during this study period. The improvement of acne as well as other associated problems were assessed by both the physicians and the patient themselves. RESULTS: Significant resolution of comedones, papules, and pustules was found. The skin texture of each candidate was dramatically rejuvenated. Consistent and repetitive treatment with glycolic acid was needed for the apparent improvement of acne scars and cystic lesions. The follicular pores also became comparatively smaller. Furthermore, most of the candidates had much brighter and lighter looking skin. Only small percentage of patients (5.6%) developed side effects. CONCLUSION: Glycolic acid has considerable therapeutic value for acne with minimal side effects even in Asian skin. It may be an ideal adjunctive treatment of acne.

Acne Vulgaris↗
PubMed1986

Hemifacial mixed appendageal tumor in an infant.

We believe this to be the first report of a unilateral mixed appendageal tumor without comedones on the face of an infant. Histologically, the tumor had eccrine, apocrine, and basaloid features. The tumor lobules closely resembled islands of basal cell carcinoma. After reviewing the literature, we speculate that some previous case reports of unilateral basal cell nevus were actually appendageal tumors with basaloid differentiation and not true basal cell carcinomas.

Apocrine Glands↗
PubMed1989

Molluscum contagiosum-induced comedo and secondary abscess formation.

A 9-year-old boy had recurrent formation of fluctuating abscesses of the forearms, leading to surgical incisions. Histopathologic examinations revealed that the etiologic agent was a molluscum virus in the lower portion of a pilosebaceous follicle, which formed a comedo. The comedones developed into pustular and cystic lesions after the boy attempted to squeeze out the contents. Two different reaction patterns to molluscum contagiosum seem to be present: a lymphocyte-mediated immunologic reaction in normally regressing lesions, and an acute inflammatory reaction due to disruption of infected epidermal tissue into the dermis, as seen in this patient.

Abscess↗
PubMed1991

Treatment of infantile cystic acne with oral isotretinoin: a case report.

Infantile cystic acne is rare, and its etiology is not clearly defined. Our patient had comedones at 2 months of age that were recalcitrant to multiple-antibiotic regimens. His condition worsened, and he was diagnosed with infantile cystic acne at 10 months of age and started on a trial of oral isotretinoin (Accutane). A five-month treatment period using doses ranging from 0.36 to 0.67 mg/kg was necessary to achieve adequate control. Oral isotretinoin may be safe and effective in cases of recalcitrant infantile acne, but we advocate close monitoring because of the well-known side effects of oral retinoids.

Acne Vulgaris↗
PubMedDate not supplied

A practical approach for the use of oral isotretinoin for infantile acne.

Infantile acne is a rare occurrence. It is more common in boys and predominately occurs on the cheeks in infants between the ages of 1 and 16 months. Clinically, the lesions range from comedones to inflammatory papulopustules to cysts. Successful therapies include topical tretinoin, benzoyl peroxide and topical and oral erythromycin. For more serious cases, oral isotretinoin (Accutane) has been reported to successfully treat recalcitrant infantile cystic acne. We describe two additional patients with infantile cystic acne treated successfully with oral isotretinoin. The dose of isotretinoin used ranged from 0.2 mg/kg/day to 1.5 mg/kg/day. The treatment duration varied from 5 to 14 months. Careful monthly monitoring is recommended because of the many side effects reported with isotretinoin. Practical tips for the administration of oral isotretinoin in infants are reviewed.

Acne Vulgaris↗
PubMedDate not supplied

A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris.

Despite the common recommendation to wash the face twice daily with a mild cleanser, there is little published evidence to support the practice. Indeed, while the general public believes that cleaner skin will result in fewer blemishes, dermatologists often warn that overwashing and scrubbing can exacerbate the condition. To clarify the effect of frequency of face washing on acne vulgaris, we designed a single-blinded, randomized, controlled clinical trial to be conducted on males with mild to moderate acne vulgaris. Subjects washed their faces twice daily for 2 weeks with a standard mild cleanser before being randomized to one of three study arms, in which face washing was to be done once, twice, or four times a day for 6 weeks. At the end of the study no statistically significant differences were noted between groups. However, significant improvements in both open comedones and total noninflammatory lesions were observed in the group washing twice a day. Worsening of acne condition was observed in the study group washing once a day, with significant increases in erythema, papules, and total inflammatory lesions. We concluded that slight support exists, both in terms of efficacy and convenience, for the recommendation to wash the face twice daily with a mild cleanser. However, excessive face washing may not be as culpable as previously thought.

Acne Vulgaris↗
PubMedDate not supplied

Update in retinoid therapy of acne.

The pathogenesis of acne, the most common skin disease, is complex and multifactorial. Clinical experience has demonstrated that parallel targeting of various pathogenetic factors, achieved either by mono- or combination therapy with appropriate drugs, represents the most effective approach to treating acne. Topical retinoids have been shown to expulse mature comedones, reduce microcomedone formation, and exert immunomodulatory effects. They have broad anti-acne activity without the risk of inducing bacterial resistance, which justifies their use as first-line treatment in most types of noninflammatory and inflammatory acne and makes them uniquely suitable as long-term medication to maintain remission after cessation of initial combination therapy. Systemic isotretinoin as a monotherapeutic agent strongly affects all four major pathogenetic factors and has been, in the hand of experienced dermatologists, a potent and safe agent for the treatment of severe and recalcitrant acne forms for more that 20 years. However, patient counseling, careful monitoring, and evaluation and management of adverse events are necessary. The use of isotretinoin has experienced a drawback now that its indication has been lowered from a first-line to a second-line medication.

Acne Vulgaris↗
PubMedDate not supplied

Maintenance therapy for acne vulgaris: the fine balance between efficacy, cutaneous tolerability, and adherence.

Maintenance therapy is defined as the regular use of appropriate therapeutic agents to ensure that acne remains in remission. Topical agents are the mainstay of maintenance therapy. A number of topical therapeutic options are available, including topical retinoids, benzoyl peroxide, and azelaic acid. The choice of topical agents should be based on a number of criteria: efficacy in addressing the subclinical microcomedo, which is the precursor lesion for both comedones and inflammatory lesions; tolerability, due to the need for application to a broader epidermal surface; and other properties that may enhance adherence. Patients may be more motivated to use agents that are easily integrated into their lifestyles and that have potential "skin-repairing" properties.

Acne Vulgaris↗
PubMed1985

Basaloid follicular hamartoma: three cases with localized and systematized unilateral lesions.

Two patients having a localized plaque of alopecia on the scalp, and one with a systematized unilateral epithelial nevus exhibited a histologically distinctive form of follicular hamartoma. In the affected areas individual hair follicles were replaced, or were associated with solid strands and branching cords of undifferentiated basaloid cells, filled in between by fibrous stroma resembling either a miniature premalignant fibroepithelial tumor of Pinkus, a small trichoepithelioma, or a basal cell epithelioma. The relation between these 3 patients and cases reported as linear unilateral basal cell nevus with comedones and generalized hair follicle hamartoma associated with myasthenia gravis is discussed.

Adult↗
PubMed1995

Basaloid folliculolymphoid hyperplasia with alopecia as an expression of mycosis fungoides (CTCL).

Follicular mucinosis, papules, cysts and comedones have been previously described as expressions of follicular involvement by mycosis fungoides. We report a patient with mycosis fungoides who developed extensive alopecia. Multiple scalp biopsies showed perifollicular and intrafollicular infiltrate of lymphocytes but no evident follicular mucinosis. On transverse sections many of the follicles showed an absence of differentiation towards hair sheath, canal, sebaceous gland or hair formation, but instead formed undifferentiated basaloid structures. These basaloid structures showed transition from atrophic telogen follicles to hypertrophic basaloid islands infiltrated by lymphocytes, resembling the pattern previously described in cutaneous lymphadenoma. Immunophenotyping showed a predominance of helper T-cells which, on ultrastructural examination, showed cerebriform nuclei. The unusual histological findings in our case may be analogous to the hyperplasia seen in sweat glands in syringotropic mycosis fungoides (syringolymphoid hyperplasia), and we propose the term basaloid folliculolymphoid hyperplasia to describe this feature. Basaloid follicular hyperplasia has been previously described as a component of follicular mucinosis but may apparently develop in the absence of overt mucinosis.

Aged↗
PubMed2005

[Adjunctive treatments for acne therapy].

The mainstays of modern acne therapy include comedolytic, antimicrobial, and anti-inflammatory substances, as well as antiandrogens. Additionally, traditional or newly developed therapeutic approaches may be considered, including pharmacologic (dapsone, zinc) and physical measures (phototherapy, photodynamic therapy, comedone extraction, abrasives). This article reviews such adjunctive therapies with regard to efficacy and their roles in acne therapy.

Acne Vulgaris↗
PubMed2006

[Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid].

Benzoyl peroxide (BPO) was introduced in the treatment of acne in 1934. Despite the fact that only few randomized trials have been published, BPO is considered the standard in topical acne treatment. Anaerobic bacteria are reduced by oxidative mechanisms and the induction of resistant strains is reduced. Topical formulations are available at concentrations of 2.5, 5, 10 and 20 %. The effect is dose-dependent, but the irritation increases with higher concentrations. Usually 5 % BPO is sufficient to control acne grade I-II. Due to its strong oxidative potential, patients should be advised that BPO may bleach colored and dark clothing, bedding and even hair. BPO is safe for use in pregnant and lactating females because it is degraded to benzoic acid. It is a cost-effective treatment for acne grade I-II. Patients with papulopustular acne grade I-II, particularly with marked inflammation, show satisfactory improvement with topical antibiotic treatment. The following compounds are available and effective: erythromycin, clindamycin and tetracycline (the latter being less frequently used). A review in 1990 suggested that topical tetracycline was ineffective in the treatment of acne. Along with eliminating Propionibacterium acnes, the main mechanism of topical antibiotics is their antiinflammatory effect. All three penetrate the epidermal barrier well and are similarly efficacious. Randomized trials have shown that in concentrations of 2-4 %, their effects are comparable to oral tetracycline and minocycline. Combination therapy with retinoids or benzoyl peroxide (BPO) increases efficacy. Retinoids increase penetration and reduce comedones, while topical antibiotics primarily address inflammation. One side effect of topical antibacterial treatment is an increase in drug-resistant resident skin flora with gram-negative microorganisms prevailing, which can lead to gram-negative folliculitis. All three antibiotics fluoresce under black light which may produce interesting effects in a discotheque. There are two reports of topical clindamycin causing pseudomembranous colitis after long-term and widespread usage. Azelaic acid has a predominant antibacterial action, although it is not considered as an antibiotic in the classical sense. Furthermore, it possesses a modest comedolytic effect. Burning upon application is common. Since azelaic acid is naturally present, systemic side effects are not likely to occur, making it safe for acne treatment during pregnancy and lactation.

Acne Vulgaris↗
PubMed1986

Mediation of hidradenitis suppurativa by androgens.

Forty two women with hidradenitis suppurativa were assessed clinically and biochemically for evidence of androgen excess. Thirteen had irregular menses; 22 of 36 experienced exacerbation of hidradenitis suppurativa premenstrually; 19 had or had had acne vulgaris; and seven were hirsute. Comedones (blackheads) were found in apocrine sites in 37, but also in retroauricular sites in 18 and were considered to be an important physical sign for early diagnosis. Eight had evidence of pilonidal (postanal) sinus. The patients had a higher concentration of total testosterone (p less than 0.01) and free androgen index (testosterone to sex hormone binding globulin concentrations) (p less than 0.01) than normal controls. Patients with hidradenitis suppurativa appear to have endocrine abnormalities sufficient to suggest an androgenic basis for the disease.

Adolescent↗