SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A case of pyoderma vegetans (PYV) and hidradenitis suppurativa (HS) is described. Our patient had a previous history of perifolliculitis capitis abscedens et suffodiens and acne conglobata. Direct immunofluorescence findings ruled out pemphigus vegetans and suggested a potential pathogenic mechanism.
Regarding treatment of acne vulgaris and rosacea, there is not much difference between hospital and practice nor among practicing dermatologists. Most of the assistants performing the important physical-manual treatment have had the same training. After analytical conversation and etiologic as well as diagnostic classification, the patients undergo the following manual treatment: cleansing, astringing, removing of comedones, massage, face pack, and covering with tinted emulsion. At home, acne: cleansing, massage, skin lotion, vitamin A acid, benzoylperoxide, antibacterial therapy; in serious male cases of acne conglobata, Roaccutan. Rosacea: antiseptic (antibiotic) treatment (topically and systemically), metronidazole (Arilin); in serious male cases, Roaccutan.
We report the case of a 35-year-old patient with secondary cutis verticis gyrata (CVG) that histologically presented as acne scleroticans capitis. Clinically, the diagnosis of acne conglobata was made. The CVG developed under systemic corticosteroid treatment of an ulcerative colitis. Corticosteroids were discontinued and a therapeutic attempt was made with isotretinoin. Although under this treatment the conglobate acne healed, the CVG remained unaltered. Dermatosurgical intervention by a scalp reduction plasty finally resulted in a marked improvement of symptoms and acceptable cosmetic outcome.
Successful treatment of acne conglobata with 13-cis-retinoic acid (isotretinoin, Ro 4-3780) has already been reported in this journal [25, 36]. The aim of the present study was to treat severe forms of papulopustular acne, unresponsive to conventional therapy, with low doses of 13-cis-retinoic acid to obtain good results with few side effects. A total of 191 patients from 14 departments of dermatology in the Federal Republic of Germany received 13-cis-retinoic acid under open randomized conditions in parallel dose groups of 0.05, 0.1, and 0.2 mg/kg body weight for 20 weeks in order to establish efficacy and tolerance. All inflammatory and non-inflammatory skin lesions were counted. The intensity of seborrhea was graded by using a scale. Adverse effects as well as laboratory values were registered. After 20 weeks of treatment a 79% (0.05 mg), 80% (0.1 mg), and 84% (0.2 mg) decrease in the number of inflammatory skin lesions was seen. Fourteen patients in the lowest dose group were considered to be dropouts. The decrease in non-inflammatory skin lesions was less marked and amounted to between 49% and 69%. A significant reduction of seborrhea could be observed in all patients. The main side effect was dryness of the skin and mucous membranes, which was, however, of low intensity. The elevation of triglyceride and cholesterol levels reported with higher doses of 13-cis-acid, especially in patients with high-risk factors, were not encountered in this study.
A patient suffering from an acute episode of acne conglobata demonstrated a transient decrease in several C5a induced polymorphonuclear cell functions, whereas the response to N-formylmethionyl peptides (FMLP) was normal.
We report two cases of the SAPHO syndrome (synovitis, acne conglobata, pustulosis palmoplantaris, hyperostosis and osteitis). This syndrome has been published in the pediatric and rheumatological literature in recent years.
Acne vulgaris is a disease affecting mostly adolescents and young adults that, when severe, has the potential to result in scarring and permanent disfigurement. Systemic treatment is necessary to prevent significant psychological and social impairment in these patients.(1) Significant inflammatory and nodulocystic acne is usually recalcitrant to topical treatment, whereas uncommon acne variants, such as acne fulminans, pyoderma faciale, and acne conglobata, need to be promptly and effectively controlled. In all of these circumstances, systemic agents are indispensable. The choices include oral antibiotics, isotretinoin, and hormonal treatment (Table 1).
The authors report, for the first time in Bulgarian literature, a case of acne tetrad syndrome in a family. The patients were sisters who were found to have three of the four components of the syndrome: hidradenitis suppurativa, acne conglobata, and cysta pillaris. There was no evidence or anamnestic data for perifolliculitis capitis abscedens et suffodiens. In one of the sisters the syndrome showed a more precipitate clinical picture and was combined with other skin disorders (lichen ruber planus, neurodermitis circumscripta, hirsutismus). The patients had a familial predisposition to acne and pilar cycts. The complete blood analysis, all biochemical parameters, the cytogenetic analysis and hormonal status (testosterone and estrogens) showed no deviation from normal values. The patients did not report any disturbances during their menstrual cycles. The cellular immunity in one of the sisters was depressed. The patients and their children will be closely monitored.
Tigason was applied in 51 patients with psoriasis and 19 with other skin diseases. In 18 patients was applied alone, in 42 combined with PUVA and in 10 with SUP. Roaccutan was applied in 18 patients with acne conglobata et phlegmonous resistant to other methods of treatment. Tigason was found to be a useful drug in psoriasis and some other skin diseases. The combination with PUVA or SUP allowed to reduce the doses of drugs and the dose of radiation. Roaccutan was found to be a useful drug in severe forms of acne vulgaris. The side effects of the treatment with retinoids were transient and they did not create danger to the patients.
Fifty-three patients suffering from acne vulgaris or acne conglobata have been treated with natural sulphides over a period of 4 weeks. All cases showed improvement; normalization of the skin could be achieved in 36 patients (67.9%).
A healthy woman aged 21 years who used the oral contraceptive Trigynon became pregnant while being treated with Minocin (minocycline; 100 mg per day) for acne conglobata. While the risk of use of antibiotics such as this one reducing the efficacy of oral contraceptives is small, patients should nevertheless be informed that the risk exists.
A case of acne conglobata with myo-osteoarticular involvement is described. The occurrence of a subacute, symmetrical polyarthritis with radiological changes was the unique feature of this patient. The immunologic work-up demonstrated impairment of delayed hypersensitivity. Control of the systemic symptoms was obtained initially with corticosteroids and during a relapse with indomethacin. Clofazimin was effective in longterm treatment of the acne. Following cessation of all therapy, there has been no evidence of recurrence of either acne or rheumatic symptoms.
Rosacea fulminans is a rare disease of unknown cause which occurs exclusively in women well past adolescence. It was previously called pyoderma faciale because of its confinement to the face covering most of the surface with innumerable fluctuant inflammatory nodules and papules which frequently fuse and form monstrosities. Seborrhea prior to onset is typical. It is not a pyoderma; neither it is infectious or a variant of acne conglobata. The patients respond well to a therapeutic regimen including isotretinoin in combination with topical and systemic corticosteroids. The response is superior and much more rapid than in patients treated with oral antibiotics. Rosacea fulminans is the only indication for topical or systemic corticosteroids in the treatment of rosacea. Scarring is often minimal when the lesions clear. No recurrence is seen.
A report is made on 80 male patients aged 19-25 and suffering from common acne, who were treated with vitamin A acid (Eudyna) partly as inpatients and partly as outpatients. All stages were present from acne comedonica to acne conglobata. The preparation was available in the form of cream and jelly, each containing 0.05% tretinoin. As a rule, the drug was applied once daily. At the end of the tretinoin treatment lasting for a maximum of 9 weeks, a decrease in comedones of more than 90% is reported. The tolerance of Eudyna was seen to be good to very good in more than two thirds of the patients.
A 22-year-old man with a known bipolar disorder was admitted to a psychiatric department for depression and suicidal ideation. He was being given isotretinoin to treat acne conglobata. During admission, he committed suicide. In the literature, isotretinoin is associated with the emergence of psychiatric symptoms. Although any casual relationship has not been identified, such a relationship cannot be ruled out. Methodologically well-performed research is lacking. However, positive dechallenge and rechallenge cases have been reported. Consequently, physicians must look out for the onset or worsening of psychiatric symptoms in patients treated with isotretinoin.
For 12 years, a 26-year-old man had acne conglobata and a non-suppurative diffuse sclerosing osteomyelitis of the mandible as part of a chronic recurrent multifocal osteomyelitis of the sternum, the pelvic bones, and the femoral head, and aseptic arthritis of the knee, the fibulotalar, and the sternoclavicular joints. This fulfills the formal criteria of the SAPHO syndrome. Repeated surgical and antibiotic treatment combined with hyperbaric oxygen caused partial improvement. Complete relief and partial disappearance of the scintigraphic lesions was achieved with long-term corticosteroids, non-steroidal anti-inflammatory drugs, minocycline, and isotretinoin.
In severe cases of acne conglobata the use of substances which considerably reduce the sebum excretion rate, such as 13-cis-retinoic acid, is reasonable. To monitor the effect of such preparation a noninvasive and accurate method for measuring skin surface lipids (SSLs) is required. A new modified photometric quantification of SSLs sampled using the cigarette paper method based on reaction with phosphovanilic reagent was introduced. Our overall results indicate that a 3-h SSLs assessment measured photometrically is as accurate as the gravimetric technique; it is reproducible in situations with low and high levels of SSLs.
A twenty year old, foreign-born sportsman visited the Out-patient Clinic of our Hospital with complaints of progressive arthralgia, hepatomegaly and increasingly abnormal liver function tests of six months duration. Tests for virus hepatitis were negative, alcohol abuse or drug addiction could be excluded. An open needle biopsy of the liver was performed and the tissue was examined with the light and electron microscope. On routine light microscopy no abnormality was recognized. Electron microscopic examination revealed changes characteristic of vitamin A toxicity: hyperplasia of the perisinusoidal (Ito) cells with evidence of their activation and transformation, increased storage of lipids and vitamin A, perisinusoidal fibrosis, damage of the sinusoidal wall, partial necrosis in hepatocytes and an increased number of lysosomes, megalysosomes and smooth endoplasmic reticulum (SER), the signs of cholestasis as well as an increased number of Kupffer cells in the lobules etc. Histochemical examination showed a high content of vitamin A in the transitional (Ito) cells and in hepatocytes. These data led to further questioning of the patient who disclosed that he had acne conglobata which had been treated with Isotretionin, 20 mg/day, for more than half a year. After the therapy was stopped, the symptoms of polyarthralgia improved and after a few months they ceased entirely, however, the laboratory data returned to normal only after a long period of time. This case indicates that electron microscopic examination of the liver biopsy may play an important role in the recognition of vitamin A intoxication. It also illustrates that symptoms of joint disease may be caused by long-term retinoid treatment. The authors have presented the latest clinical and experimental data concerning the changes in the liver, joints and skeleton caused by retinoid intoxication.