ACNE RELATED CONDITIONS

- It is a disorder affecting the pilosebaceous units of the skin

A) Non-Inflammatory acne lesions (comedones)

1) Open comedones (black heads)
2) Closed comedones (white heads)

Clinical presentation:
found in areas with numerous sebaceous glands.

B) Inflammatory acne lesions

1) papules
2) pustules
3) nodules or cysts

CLINICAL FINDINGS
• Scar, nodules & cyst

Type of acne:
• Conglobata
• Fulminans
• Neonatal
• Steroid acne
• Acne-form eruption

Pathogenesis:
• Androgens
• Follicular obstruction
• Propionobacterium acne

Therapy:
 topical agents
 systemic antibiotics
 systemic retinoid

Topical agents:
Topical comedolytic agents are:

• Tretinoin (Retin A) available in cream, gel and solution formulations.

• Benzoyl peroxide available in 2.5%, 5% and 10% concentrations
• Both can cause skin irritation (worse at first 1 to 2 weeks)
• Topical antibiotics: Clendamycin and erythromycin.

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Systemic antibiotics:
• Tetracycline (500 mg twice/day) is the antibiotic of first choice because of its
low cost, efficacy and relative safety. Must be taken on an empty stomach.
• Erythromycin (500 mg twice daily) the next most often used systemic
antibiotics.

Systemic retinoids:
• Isotretinoin (Accutane)
• Vitamin A analogue
- Decreases follicular keratinization, sebum production and intrafollicular bacteria
count.

Side effects:
• Almost all patients experience chapped lips and dry skin
• Increase liver enzymes
• Increase lipids
• Teratogenic

* Special consent forms, strict birth control measures and monthly pregnancy test are
required for female in the productive period.

ROSACEA
Chronic inflammatory disorder affecting the blood vessels and pilocebaceous units of
the face.

CLINICAL FINDINGS
• Papules and pustules are super imposed.
• On a background of erythema and telangiectasia
• On the central third of the face

Differential Diagnosis:
- Lupus erythematosus
- Photodermatitis
- Carcinoid syndrome

Complications:
- Rhinophyma
- Ocular complications
- Blepharitis
- Conjuctivitis
- Keratosis (may lead to blindness)

Treatment:
- Low dose tetracycline or erythromycin (250 mg twice daily)
- Topical metronidazole 0.75% gel (metro gel) is effective in treating papules,
pustules and erythema of rosacea.
- Isotretinoin (Accutane) – for resistant cases.
- Avoid stronger cortisone preparations and sun exposure.

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PERIORAL DERMATITIS
- Papules and pustules
- Cosmetic related
- Sparing zone
- No comedones nor telangiectasia
- Rx – avoid the offending cause