[13-cis retinoic acid in the oral therapy of acne conglobata. Results of a multi-center study].
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A 16-year-old boy developed arthritis and osteitis (anterior thoracic wall, ankle of left foot, spinal column) within 5 weeks of an exacerbation of acne. Both the local skin condition and the locomotory system improved after treatment, but sternocostoclavicular hyperostosis persisted. The syndrome of acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome) identified in 1987, represents an entity usually classified as one of the seronegative spondylarthrites close to ankylosing spondylarthritis and psoriatic arthritis.
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Four weeks after the introduction of a therapeutic regimen with 80 mg 13-cis-retinoic acid/day, a 16-year-old male patient developed oozing hypergranulation with vulnerable masses within acne lesions. These local symptoms were accompanied by fever, fatigue, weight loss, polyarthralgia and myalgia, similar to acne fulminans. In spite of these unusual reactions treatment was continued. Local steroid ointments were additionally applied. Within a short period of time regression of granulations and normalization of the general health condition was observed. After 4 months, therapy was discontinued. The patient's acne had totally healed and did not relapse within an observation period of 2 years.
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Patients with hidradenitis suppurativa/acne conglobata attending a university medical center were evaluated for the presence of an associated arthritis. Of 44 subjects, 21 had objective evidence of inflammatory arthropathy. Of these 21, all adults, 11 were women and 17 black Americans; clinically, 18 had peripheral arthritis, 15 axial arthropathy and 12 both. Clinical and laboratory findings were characteristic of those seen in other seronegative spondyloarthropathies, except for lack of association with HLA-B27.
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Good to excellent clinical results have been obtained in the treatment of severe inflammatory acne (acne conglobata, acne fulminans, and acne conglobata with hidradenitis and dissecting cellulitis of the scalp) with orally administered isotretinoin (13-cis-retinoic acid). Similar promising results have been obtained in patients with severe rosacea and gram-negative folliculitis. Isotretinoin probably has multiple modes of action, including (1) inhibition of sebaceous gland activity, (2) inhibition of the growth of Propionibacterium acnes within the follicle, although the retinoid is not antibacterial, (3) inhibition of inflammation, and (4) alteration of the pattern of keratinization within the follicle, as demonstrated by light and ultrastructural studies.
The draining sinus is an unpleasant complication of acne conglobata, acne fulminans, acne inversa, rosacea conglobata and rosacea fulminans (pyoderma faciale). It is most common on the face, especially in the nasolabial folds, and on the neck below the mandibular line. Clinically, it is an elongated (2-5 cm long), elevated, periodically inflamed lesion, which sporadically discharges pus. The lesion persists with no tendency to spontaneous regression. Histopathologically, it consists of elaborate, epithelialized galleries connected to the skin surface at multiple points. It contains corneocytes, hairs, bacteria, serum, inflammatory cells and epitheloid granulomas. A surgical thread placed into the skin provides a model in which the generation of sinus tracts can be studied. Therapy is difficult. Intralesional corticosteroid injection, cryosurgery and isotretinoin are not always very effective. Sometimes complete excision of the lesion is necessary. The draining sinus is a special form of scar analogous to the pilonidal cyst.
Common acne, the most frequently occurring dermatosis of adolescence may lead to mentally unstable states, even depression, due to localization, its very prolonged duration, and in some patients leaving deforming cicatrices. The objective of the present paper is to answer the following questions: which treatment procedures were used for curing patients with different types of acne who were admitted to Department of Dermatology, Silesian Medical School, Katowice, Poland, in the years between 1991 and 2000. During 1991 to 2000, 206 patients were hospitalized with the diagnosis of acne. Mean age of patients was 25.51 years. The following types of acne were recognized: 108 patients--acne punctata, 82--acne conglobata, 4--acne fulminant, 4--papulous-pustular acne, 8--inverse acne, respectively. Analyses have been performed on the basis of case records related to patients admitted to Department of Dermatology, and registered at Outpatient Clinic in the years 1991-2000. It has been proven that there existed a substantial statistical difference between the age of patients affected by acne conglobata and inverse one and those suffering from acne conglobata and acne punctata. A significant difference in the age between the group of patients locally treated and the group of those cured by Roaccutane was observed. The results obtained point out that most frequently diagnosed cases: acne conglobata and acne punctata were treated by Roaccutane and locally, respectively. Results obtained revealed that the percentage of patients treated orally by retinoids showed a rising tendency, while a relatively constant percentage of local treatment methods (strongly marked in the late 1990s) and variable rate of administered antibiotics for curing acne was observed.