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[Antiandrogens and acne].

One hundred forty-four patients with acne, in most cases severe, were treated with cyproterone acetate, either at low dose ( Diane : 2 mg daily for 21 days), or at high dose ( Androcur : 50-100 mg daily for 10 days) in an inversed sequential schedule according to Hammerstein . The comparison between the two groups of patients exhibits an highly significant difference in favour of Androcur , as well on seborrhea as on comedones and eruptions, whatever the dose (50 or 100 mg); similarly, the results of Androcur were the same with or without topical treatment (Tretinoin or Benzoyl peroxide). The tolerance was equally good in the two groups.

Acne Vulgaris↗

[Experiences in dermatologic practice with combined external treatment of acne with benzoyl peroxide and erythromycin].

Fifty patients consulting my dermatologic practice because of facial papulopustular acne varying from grade I up to grade IV (according to Plewig and Kligman) have been treated with benzoyl peroxide and erythromycin. The more severe cases (grades III and IV) received additional treatment, such as tetracycline or cyproterone acetate internally and/or, externally, removal of comedones as well as UV-A-radiation. As a result, 68 percent of all patients showed remission in at least 70 percent of their inflammatory skin eruptions.

Acne Vulgaris↗

[The association tretinoin-erythromycin base: a new topical treatment for acne. Results of a multicentric trial on 347 cases (authors transl)].

A multicentric trial involving ten dermatological departments was conducted to evaluate the efficacy and tollerance of ANTIBIO-ABEREL (an association of Tretinoin and Erythromycin base) in 347 patients with persistant acne. Complete healing or considerable improvement was obtained in 85% of cases. This new treatment was active against both inflammatory lesions (papules and pustules) and retentional elements (microcysts and open comedones). It was also rapidly active, as very favorable results were obtained in ten weeks or less, in more than half of the cases. The tolerance was remarkable (less than 1% of cases had to interrupt treatment). This product represents an important progress as compared to Tretinoin alone. No other local or systemic therapy, especially long term antibiotherapy, is required.

Acne Vulgaris↗

Favre-Racouchot syndrome associated with radiation therapy.

A 56-year-old woman developed Favre-Racouchot syndrome involving her face and scalp primarily at the sites of x-ray irradiation for therapy of an astrocytoma. The patient had not had comedones prior to radiotherapy and did not have a history of excessive sun exposure. The patient showed an excellent response to topical retinoic acid gel. To the best of our knowledge, this is the first case of Favre-Racouchot syndrome developing after radiation therapy to be reported in the literature; its pathogenesis is discussed in this paper.

Brain Neoplasms↗

Clinical evaluation in acne.

Various methods for clinical evaluation of the effect of treatment of acne vulgaris have been studied. Counting of acne lesions was found to be more sensitive than the opinion of the patients and the assessment of colour photographs. The correlation between the results obtained by lesion counts and evaluation by photographs was low, as was also the reproducibility of photographic assessment. This methodological study was performed during a 6 week period, using a double-blind technique for comparing the effect of 0.6 g of oral zinc sulphate daily versus placebo in 54 patients. With zinc treatment acne improved with about one third as rated with a score system. Compared to placebo this result is slightly better (p less than 0.05). Inflammatory acne of grades 2-3 responded more favourably than comedonal acne to zinc treatment.

Acne Vulgaris↗

[Peroxidation of lipids in the inflammatory process].

Lipidoperoxidation in the sebum from 10 subjects suffering from inflammatory acne has been shown by use of mass spectroscopy, in contrast with 10 normal subjects where this was not observed. Peroxidation of sebum lipids is probably linked with the inflammation of the comedons.

Acne Vulgaris↗

Acne vulgaris: therapy directed at pathophysiologic defects.

An effective therapeutic regimen for the treatment of acne vulgaris is presented. The emphasis is based upon correcting a defect in keratinization of the sebaceous follicles with a combination of vitamins A and E. This prevents the formation of milia and comedones, thus depriving the Propionibacterium acnes of a culture medium. Vitamin E also prevents irritating lipid peroxidation of sebum, damaged by bacterial growth, which may be responsible for the inflammatory aspects of acne. No antibiotics were employed in the series of 98 consecutive cases examined herein.

Acne Vulgaris↗

Topical deodorized polysulfides. Broadscope acne therapy.

True Vleminckx's solution incorporated in a natural clay-mask vehicle apparently retains its therapeutic qualities while relinquishing all unaesthetic properties. A double-blind, randomized clinical trial comparing the Vleminckx mask to its vehicle was conducted. While the mask vehicle may not be considered a placebo, only the active drug produced a statistically significant reduction in comedone count at the conclusion of the study. The Vleminckx mask achieved a substantially greater reduction in papule count than the vehicle (p less than 0.05). Male and female patients responded positively to the concept of every-other-evening applications of only 20 minutes, as well as to the mask's rapidly astringent and cooling skin effects.

Acne Vulgaris↗

[Atrophodermia vermiculata vera (author's transl)].

A net of yellow reticular ledges with red pseudoatrophic areas in between developes on both cheeks of a 16 years old boy, increasing since about 4 years. Additionally there are some milia and comedones. Histologically large amounts of elastic material are to be seen in the interfollicular spaces. This material does not perforate the epidermis. The boy's mother has similar but less pronounced skin changes.

Acne Vulgaris↗

Various parameters for grading acne vulgaris.

Two 12-week-long double-blind placebo-controlled studies of acne treatments were performed using three judges and a total of 331 male college students. Global severity grades and papule, pustule, and comedo counts were performed every two weeks. The data were evaluated using Pearson's coefficient of correlation, and results showed a high degree of correlation between global severity grades and lesion counts, as well as among judges. These data suggest that acne grading scales and papule counts are equally reproducible methods of grading inflammatory acne and that the comedo grading scale and comedo count are equally reproducible methods of grading comedonal acne.

Acne Vulgaris↗

Reticulate pigmented anomaly of the flexures. Dowing Degos disease, a new genodermatosis.

Acquired reticulate pigmentation of the flexures developed in ten patients. Additional features in some cases were pitted scars near the angles of the mouth and scattered dark comedone-like lesions on the neck (dark dot follicles). The disease affects both sexes, usually develops in early adult life, and is slowly progressive. The abnormality is characterized by pigmented filiform epidermal downgrowths closely resembling an adenoid seborrheic wart, but similar proliferations also develop around the variably dilated pilosebaceous follicles. The occurence of the anomaly in siblings and in mother and daughter in two families suggests the condition in a new genodermatosis. Reticulate pigmented anomaly of the flexures bears a spurious clinical resemblance to acanthosis nigricans and, thus, the recognition of this new genodermatosis should spare patients undergoing unnecessary investigations to exclude visceral malignancy.

Acanthosis Nigricans↗

[Classification of follicular cysts: epidermal cysts including Günther sebocystomatosis, steatocystoma multiplex and trichilemmal cysts].

The clinical and histopathological nomenclature of various follicle-derived cysts is confusing. A uniform terminology, based on histopathological criteria is proposed. Cysts may develop from vellus follicles, sebaceous follicles, and terminal hair follicles. The various sections from each follicle may give rise to various types of cysts: 1. the infundibulum to epidermal cysts (e.g. epidermal cysts, comedones, milia, and scrotal cysts); 2. the sebaceous ducts and sebaceous acini to steatocystoma multiplex; 3. the infraglandular portion of the infrainfundibulum to trichilemmal cysts (atheromas). A clinical variant of epidermal cysts, the scrotal cysts, at times incorrectly called sebocystomatosis Günther, is described in 10 patients. For all types of cysts clinical and histopathological guidelines are offered.

Cysts↗

Trichostasis spinulosa.

Usually occurring on the mid-face, especially on the nose, trichostasis spinulosa occurs more commonly in young, adult black women. The lesions of trichostasis spinulosa resemble open comedones (blackheads). It may be treated with tweezing, dipilatory wax, and topical retinoic acid.

Adult↗

A human model for assessing comedogenic substances.

Substances that are moderately to strongly comedogenic in the rabbit ear model test have been found to be capable of inducing comedones in the human model described in this report. The test substances are applied under occlusion for one month to the upper part of the backs of young adult, black men who have large follicles. The degree of follicular hyperkeratosis is assessed by a noninvasive "follicular biopsy" techniques, employing a fast-setting cyanoacrylate glue to remove the follicular contents. The rabbit model is more sensitive than the human. Substances that are weakly comedogenic in the rabbit are probably safe for human use with the possible exception of acne-prone persons.

Animals↗

Lichen planus and acne provoked by gold.

A 58-year-old man with rheumatoid arthritis developed lichen planus during treatment with gold. Four months after cessation of treatment, a severe acne with comedones, papules, pustules, and small cystic elements broke out. No connection could be demonstrated between the eruption and other drugs or chemicals. Acne provoked by gold seems not to have been described elsewhere. The case history confirms that gold treatment, even in the same patient, can give rise to a wide range of skin disturbances, which in many cases do not break out until long after the drug has been withdrawn.

Acne Vulgaris↗

[A new dermato-surgical therapy for the Favre-Racouchot syndrome (author's transl)].

A new dermato-surgical method for the treatment of the Favre-Racouchot syndrome is introduced. The cysts and comedones are excised in parallel stripes by means of a small electrically driven dermatome. Thus a number of cysts is only partly cut. These remaining lesions are completely repelled with the eschar. This dermatomy gives excellent cosmetic results and should be considered for the therapy of the syndrome.

Dermatologic Surgical Procedures↗

Blood polychlorinated biphenyls and manifestation of symptoms in chronic "Yusho" patients.

The correlation between blood PCB concentration and clinical manifestation of symptoms was investigated in 259 chronic "Yusho" patients, using the information obtained from the nationwide health examination conducted in 1988, twenty years after the outbreak. Concentrations of blood PCBs ranged 0.6-32.0 ppb (mean; 4.78), and they were categorized into approximate quartile for analysis. For general fatigue, odds ratios at 2.7+, 4.1+, and 6.1+ ppb were 2.4, 3.6, and 3.1, respectively, with a reference category of < 2.7 ppb (test for trend; p < 0.005). For numbness in extremities, the corresponding odds ratios were 2.8, 2.8, and 2.9(p < 0.005). For comedone, they were 1.4, 1.0, and 4.0 on face (p < 0.025); and 3.6, 4.6, and 9.5 on trunk (p < 0.005), respectively. A distinctive increase in odds ratio was observed at 2.7 ppb for these two subjective symptoms; and at 6.1 ppb for skin symptoms. The blood PCB concentrations among patients were relatively close to the normal subjects. Therefore, the observed correlations may be due to the effects of PCBs with a peculiar pattern in components, PCQs or PCDFs, taken and retained in the patients. Association with blood PCBs was also suggested for headaches; abnormal breath sounds; and acneiform eruptions in the genital region, but were statistically insignificant. None of the eye symptoms showed significant association with blood PCBs.

Adult↗

Management of acne vulgaris.

Acne vulgaris can affect both adolescents and adults. The pathogenesis of acne is multifactorial and involves overproduction of sebum, an abnormal follicular keratinization process, proliferation of Propionibacterium acnes, and hormonal and immunologic factors. Clinical manifestations of acne range from noninflammatory comedones to inflammatory papules, pustules and cysts. Current therapy allows the physician to select a variety of topical and/or systemic antibiotics, retinoids, and hormone agents aimed at specific pathogenic factors. Most treatment regimens require several weeks of consistent use to be effective. Sound patient education, a strong therapeutic alliance and modification of lifestyle factors are powerful adjuncts to medical management.

Acne Vulgaris↗