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PubMed1983

[Oral 13-cis-retinoic acid therapy in adenoma sebaceum symmetricum and the most severe forms of acne and rosacea].

Twenty-one patients with severe acne (acne papulopustulosa, acne conglobata, acne cystica), six patients with severe rosacea (rosacea paulopustulosa, rosacea conglobata, rhinophyma), and three patients with tuberous sclerosis were treated with 13-cis-retinoic acid for 6-48 weeks. Most patients had been previously treated with dermabrasion, antibiotics or metronidazole. Dependent on the severeness of the pathological symptoms 13-cis-retinoic acid was administered at a dose of 0.2 to 0.5 mg/kg body weight and was then reduced every 4 weeks. We confirm the sebostatic and antiinflammatory effect of the 13-cis-retinoic acid and long-lasting remissions. Side effects had not been serious.

Acne Vulgaris↗

PubMed1981

Anti-inflammatory effects of 13-Cis-retinoic acid. An in vivo study.

Sixteen patients with care acne conglobata, acne fulminans, acme tetrade were treated orally with 13-cis-retinoic acid, 1-2 mg/kg body weight for 12 weeks. A maintenance dose of 0.5 mg/kg in ten cases and the use of no further medication in six other cases for an additional 12 weeks followed. A 40% potassium iodide ointment was used on the upper back under occlusive dressing conditions to induce an inflammatory reaction. Four inflammatory parameters were assessed in all subjects before and during oral treatment: erythema (0-2+), edema (0-2+), papules (numbers), and pustules (numbers). All patients showed excellent improvement. Additionally, the inflammatory reaction in all patch-tests was significantly reduced: erythema from 1.13 to 0.34 (P less than or equal to 0.01); edema from 1.06 to 0.25 (P less than or equal 0.0005); papules from 6.75 to 1.86 (P less than or equal to 0.01); and pustules from 10.44 to 1.56 (P less than or equal to 0.0025). We suggest that 13-cis-retinoic acid acts as a strong anti-inflammatory agent in addition to its known function as a sebostaticum.

Acne Vulgaris↗

PubMedDate not supplied

Disfiguring draining sinus tracts in a female acne patient.

A 17-year-old girl with a 9-month history of papulopustular acne developed disfiguring, highly inflammatory, fluctuant nodules in both nasolabial folds within 2 months. Periodically she experienced discharge of pus and blood from these lesions. A diagnosis of disfiguring draining sinus tracts associated with acne vulgaris was made. The therapeutic regimen included intralesional corticosteroid injection, systemic corticosteroids along with a macrolide antibiotic, and systemic isotretinoin to reduce the inflammatory process. Outcome was favorable, with no recurrences during the following 10 months. Draining sinus is a malevolent lesion usually seen in severe forms of acne such as acne conglobata, acne fulminans, and acne inversa. Treatment is difficult and often unsatisfactory. In many cases, excision of the lesion is necessary to provide a permanent cure.

Acne Vulgaris↗

PubMed1988

[The acquired hyperostosis syndrome. 2].

In the second part of this publication, we describe some additional findings in cases of sternocostoclavicular hyperostosis. These include focal hyperostosis of the spine, in the pelvis and in the extremities and psoriatic skin lesions and severe forms of acne (acne conglobata, acne fulminans). Other features, which are not diagnostic, include erosive or non-erosive peripheral arthritis and unilateral or bilateral sacro-iliitis. An analysis of our 13 patients and of the relevant literature indicates that the hyperostosis is due to increased bone metabolism and heterotopic ossification of fibrous tissue and that these are the pathogenic bases of the changes in the axial skeleton, the pelvis and the bones of the extremities. We have suggested a scheme which would categorize the syndrome into complete, incomplete and possibly acquired forms.

Adult↗

PubMedDate not supplied

Two cases of musculoskeletal syndrome associated with acne.

We report two cases of musculoskeletal syndrome (myalgia, arthralgia, arthritis, hyperostosis) that developed in male adolescents who had severe acne (acne conglobata and acne fulminans). In both patients the hyperostosis of the right clavicle aroused the suspicion of a bone tumor or osteomyelitis, which was excluded by histologic examination. Radiologic and laboratory characteristics of musculoskeletal syndrome associated with acne conglobata and acne fulminans are reviewed as well as isotretinoin therapy. The problems of differential diagnosis are also discussed.

Acne Vulgaris↗

PubMed1990

[Acne conglobata-like exacerbation of acne vulgaris following administration of anabolic steroids and vitamin B complex-containing preparations].

This article reports the aggravation of preexisting acne vulgaris in a 21-year-old male patient due to the abuse of anabolic drugs during body-building training. After cessation of anabolic drugs the acne healed, leaving hypertrophic scars. This case report shows that the acute aggravation of an acne vulgaris should cast suspicion on the use of hormone preparations.

Acne Vulgaris↗

PubMed1986

[Systemic inflammatory reactions and extracutaneous manifestations of acne vulgaris].

166 patients suffering from acne of different severity were examined with regard to associated systemic manifestations. 74 of the patients showed acne conglobata, 12 acne tetrade, 11 acne fulminans, and 69 acne papulopustulosa. Subjective symptoms like weakness, fever, and arthralgia, as well as unspecific serological inflammatory parameters and internal symptoms were taken into consideration. Acne papulopustulosa was not associated with any internal symptoms. Such extracutaneous reactions were observed, however, in severe forms of acne as in acne tetrade or acne conglobata (41% vs 17%). Acne fulminans revealed musculoskeletal manifestations and severe inflammatory signs in the blood. The high rate of kidney involvement with severe inflammatory types of acne was alarming. Three patients developed on acute glomerulonephritis, which evolved into a chronic form in two patients.

Acne Vulgaris↗

PubMed1992

The prevalence of acne on the basis of physical examination.

BACKGROUND: It has been suggested that cystic acne is rare in women 15 to 44 years of age and infrequent in men. OBJECTIVE: To determine the prevalence of acne, we analyzed the primary data from the National Health and Nutrition Examination Survey (NHANES) that included a cutaneous examination of a stratified random sample of 20,749 noninstitutionalized U.S. residents. METHODS: We calculated the prevalence of various disease states based on NHANES primary data and the NHANES population weights. Prevalence estimates and male/female ratios of these estimates were calculated. RESULTS: From 1971 to 1974, the projected prevalence of acne conglobata (grade IV acne) for women and men 15 to 44 years of age in the United States was 250,000 and 570,000, respectively. At the time of examination, an additional 582,000 women and 749,000 men were projected to have moderate acne with cysts and scars. Therefore the prevalence of acne conglobata and acne of at least a moderate degree with cysts and scars was 832,000 for women and 1,319,000 for men 15 to 44 years of age. The male/female ratio for acne with cysts and scars is approximately 1.6:1. CONCLUSION: The NHANES examination data demonstrate that acne with cysts and scars is common in both men and women.

Acne Vulgaris↗

PubMed1991

Musculoskeletal syndromes associated with acne.

The acne conglobata (AC)-, acne fulminans (AF)-, and isotretinoin-associated musculoskeletal syndromes are three distinct clinical entities. The AC-associated musculoskeletal syndrome occurs primarily in black men over the age of 22, who develop sacroilitis with or without a peripheral arthropathy. In contrast, the AF-associated musculoskeletal syndrome is found almost exclusively in white male teenagers. Fever, weight loss, and arthralgias are prominent components of this syndrome. A unique feature of the AF-associated musculoskeletal syndrome is osteolytic lesions that occur most frequently in the clavicle, sternum, long bones, and ilium. The isotretinoin-associated musculoskeletal syndrome occurs with equal frequency in male and female acne patients. Mild, transient myalgias and arthralgias are very common and do not require discontinuation of isotretinoin therapy. Asymptomatic, small, hyperostotic lesions of the spine occur in approximately 10% of acne patients with the isotretinoin-associated musculoskeletal syndrome.

Acne Vulgaris↗

PubMed1997

Acne fulminans and erythema nodosum during isotretinoin therapy responding to dapsone.

Acne vulgaris is very common, 85% of teenagers being affected at any one time. In most cases, the disease is mild and patients do not present to the dermatologist. Most are instead treated with over-the-counter products and conventional treatment such as peeling agents or topical and systemic antibiotics. Isotretinoin has revolutionized the treatment of severe acne unresponsive to oral antibiotics. Explosive and very severe acne such as pyoderma faciale, acne conglobata and acne fulminans are rare, the features that distinguish acne fulminans from the other conditions being systemic upset with fever, joint pain, malaise and leucocytosis, while there have been two reports of the condition associated with erythema nodosum. The recommended treatment for acne fulminans is a combination of oral steroids and systemic antibiotics, isotretinoin probably not being the treatment of choice. We now report a patient who developed acne fulminans and erythema nodosum within 3 weeks of starting isotretinoin and then responded to dapsone without oral steroids.

Acne Vulgaris↗

PubMed1998

Monitoring of isotretinoin therapy by measuring the plasma levels of isotretinoin and 4-oxo-isotretinoin. A useful tool for management of severe acne.

BACKGROUND: Isotretinoin for oral therapy in severe acne conglobata and acne nodulocystica represents a significant achievement; however, the drug exerts several mucocutaneous and systemic adverse effects, besides its teratogenic potency. OBJECTIVE: The aim of this study was to investigate the plasma levels of isotretinoin and of 4-oxo-isotretinoin over long-term treatment of severe acne and to assess any correlation with the given dose, the clinical improvement and the occurrence of side effects. METHODS: Forty-one patients with severe acne and acne-related disorders were studied under long-term oral intake of isotretinoin. Therapeutic effects and side effects were evaluated prior, during and at the end of therapy. The plasma levels of isotretinoin and of its major metabolite 4-oxo-isotretinoin were measured by reversed-phase HPLC and were correlated with the administered oral dose and the number and frequency of side effects. RESULTS: Dose-dependent plasma levels of isotretinoin and its metabolite were observed. At a mean dosage of 0.75-1.0 mg/kg/day, 404 +/- 142 ng/ml were measured, whereas the plasma levels of 4-oxo-isotretinoin were 1-2x higher. The plasma levels correlated well with the orally administered dose of isotretinoin and the observed mucocutaneous side effects. CONCLUSION: The study demonstrates that measuring of the plasma levels may be a helpful tool to monitor the individual therapeutic dose regimen in patients with severe acne in order to minimize undesired side effects and to control oral intake.

Acne Vulgaris↗

PubMed2001

[Dermatologic aspects of SAPHO-syndrome].

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy.

Acne Vulgaris↗

PubMed1965

LINCOMYCIN IN DERMATOLOGIC PRACTICE.

In clinical studies with a new oral antibiotic, lincomycin, excellent results were obtained in the treatment of carbuncles, furuncles, folliculitis, cellulitis, lymphangitis, lymphadenitis, pyonychias and dermatitis infectiosa eczematoides due to coagulase-positive Staphylococcus aureus and to Streptococcus hemolyticus Type A. Encouraging results were noted in a small series of acne conglobata (cystic acne). Loose stools and diarrhea were frequently encountered but these symptoms abated when the dosage was reduced.

Acne Vulgaris↗

PubMed2005

[Side effects of treatment with isotretinoin in patients with acne].

AIM: The objective of the present paper is to assess side effects linked to the treatment of severe acne forms with administration of isotretinoin systemic and various drugs applied locally and/or systemic. MATERIALS AND METHODS: All the examinations were carried out on patients suffering from severe acne (n=206; 126 F and 80 M) hospitalized in Department of Dermatology, Silesian Medical School, in the years of 1991-2000, as well as amongst patients who continued their therapy in the outpatient clinic of the Dermatology Department during this period. RESULTS: When assessing the individual groups, the following conclusions have been drawn: lack of the relationship between the diagnosis and the therapeutical process in the group of patients locally treated and in the groups of sick persons cured by other methods; there exists a very significant relationship between the diagnosis and the therapeutical process in the group of patients to whom the isotretinoin preparation was administered and in the group of patients locally cured. The obtained results showed that the most frequently encountered diagnoses, i.e. acne conglobata and acne papulous-pustular were treated by the isotretinoin preparation and via local therapy, respectively. In the period of hospitalization, the value p=0.5570 testifies to lack of relationship between the number of side effects and the treatment period. All side effects occurred almost exclusively in patients cured by the isotretinoin preparation. The test value, p=0.0418 computed for all the periods, has revealed statistically significant relationships between the female/male sex and the side effects, most frequently reported in male patients. For the purpose of analysis the two (2) more often groups of symptoms were taken into consideration: dermal changes and biochemical disturbances and/or dysfunctions. The value p=0.5312 (p>0.05) excludes the existence of statistically significant relationship between the kind of a specific symptom and the therapy period. CONCLUSIONS: The performed medical examinations permitted to find out that side effects could be often recorded in a group of patients subjected to generally applied isotretinoin but it is never caused to stop therapy.

Acne Vulgaris↗

PubMed1990

[Acne and its drug treatment].

The most common disease of the pilosebaceous follicle is acne vulgaris. The primary detectable pathologic defect in acne is abnormal keratinization of the follicular epithelium, resulting in a retention hyperkeratosis. The primary lesion produced by this process, the comedo, ist the precursor of most other acne lesions. These include inflammatory papules, pustules and nodules. Treatment principles are directed against known pathogenic factors. The major topical modalities that are currently being used include tretinoin, benzoyl peroxide and topical antibiotics. Benzoyl peroxide is a powerful antibacterial agent. Topical erythromycin and clindamycin appear to have equivalent efficacy. A major treatment advance has been heralded by the use of oral 13-cis retinoic acid (isotretinoin) in the management of patients with severe nodulocystic acne, acne conglobata and acne fulminans. Isotretinoin is teratogenic and should not be given to women of childbearing age.

Acne Vulgaris↗

PubMed1988

[Surgical therapy of the acne tetrad].

On the basis of a 3 years experience with surgical treatment of acne tetrad (acne conglobata, apocrine acne) in 22 patients, we can draw the following conclusions: 1. Radical surgical excision yields better long-term results than local incision. Recurrences are mostly the result of non-radical surgery. 2. In cases of limited acne--especially if it is localized either in the axilla or the groin--primary wound closure may be successfully attained. 3. Gentamycin chains may support the primary wound healing in defect closures of infected areas. 4. In the axilla, we suggest wound closure by myocutaneous island flaps as the best procedure after extensive excision. 5. Specific antibiotic protection, perioperatively, according to previous culture and sensitivity testing can guarantee a postoperative course free from infection. 6. Open wound therapy with secondary healing of the soft tissue defects proved to be the treatment of choice in perineal procedures. 7. In view of the poor prognosis of conservative methods in chronic acne, and because of the risk of subsequent manifestation of chronic septicemia, early surgical excision is desirable.

Acne Vulgaris↗

PubMed1980

[Pyroderma fistulans sinifica associated with congenital alpha-1-antitrypsin deficiency].

A patient is reported who suffered from pyodermia fistulans sinifica (acne conglobata sinifica, acne tetrade) and who presented a severe congenital alpha-1-antitrypsin deficiency (phenotype ZZ). The possible significance of the protease inhibitor deficiency for the development of this disease is discussed. Alpha-1-antitrypsin deficiency has been observed in several dermatoses (panniculitis, cutaneous vasculitis, Ehlers-Danlos syndrome, acquired angioneurotic edema and cold urticaria). The insufficient neutralization of liberated leukocyte proteases has been considered to play an important role in these disorders. Besides the ultrastructural finding in the liver cell which is typical for alpha-1-antitrypsin deficiency crystals were found as are seen in the cholesterol ester storage disease. This was probably caused by an increased influx of fatty acids.

Female↗

PubMed2004

Low dose isotretinoin combined with tretinoin is effective to correct abnormalities of acne.

BACKGROUND: Isotretinoin is well known in the therapy of acne papulopustulosa and acne conglobata. No study has investigated the pathophysiological changes of the skin of acne patients, especially when low dose oral isotretinoin is given in combination with topical tretinoin. PATIENTS AND METHODS: 28 patients were treated for 6 months with oral isotretinoin. In the acne conglobata group (A-C) patients were treated with 10 mg (Group A) or 20 mg isotretinoin (Groups B, C) in combination with topical 0.05% tretinoin cream. Group C was treated the first 2 weeks with 0.05% betamethasone valerate cream instead of tretinoin cream. In the acne papulopustulosa group, the patients received 0.5 mg isotretinoin/kg bodyweight and 0.05% tretinoin cream, either alone (Group E), or with oral methylprednisolone during induction (Group D). RESULTS: Acne conglobata--A reduction of inflammatory lesion by 87-94% and of non-inflammatory lesions by 81-88% was achieved (Groups A-C). A reduction of sebaceous gland size by 35-58%, sebum production by 90-95%, follicular keratinization by 55-70% and Propionibacteria by 33-73% was seen (Groups B and C better than Group A). In Group A the amount of lipids was only reduced by 6%, in Group B by 35% and in Group C by 40%. Acne papulopustulosa--Sebum excretion rate and follicular keratinization were reduced in Group D by 89% and 50% respectively, with isotretinoin alone by 94% and 53%. The amount of lipids was reduced in Group D by 40% and in Group E by 21%. CONCLUSIONS: Because of the efficacy and cost-benefit relationship of isotretinoin in the treatment of acne compared to other therapeutic approaches, further use low dose isotretinoin in the described settings seems to justified.

Acne Vulgaris↗