Acne: Uncommon Association

They are miscellaneous groups of diseases which coexist with acne.

(1) Acne excoriee: This usually occurs in females. Two types are there, first without any inflammatory lesion and the other with mild primary inflammatory acne lesions. This is usually seen in a female who fiddle with the skin and exacerbate the small lesion. Contact dermatitis should be excluded. Patient commonly suffer from personality or psychological problem.
Treatment is with oral antibiotics like oxytetracycline 0.5 gm twice daily or with lymecycline once daily for several months. Topical ointments are of no use, they only irritate the skin and aggravate the situation. Advice should be given not to pick the spots, which is very useful. After treatment with oral antibiotics patient get fewer spots to play with.

(2) Apert’s Syndrome: It is a disease where epiphyseal closer occurs early due to androgen mediated events like acne. The characteristic facial abnormalities are flattened occiput, hypertelorism (abnormally increased distance between two organs or parts) proptosis (bulging of eyeball) due to shallow orbit, prognathism (abnormal protrusion of one or both jaws mainly lower jaw), parrot beaked nose and fused shortened digits. Two genetic mutations on fibroblastic growth factor has been blamed for the causation of the disease. Because of all the above the patient has a characteristic appearance with extensive acne. Acne usually occurs at uncommon sites like arms. Treatment of this type of acne do not respond well to antibiotics and need isotretinoin.

(3) Darie’s Disease: It is associated with acne, usually nodular type and very difficult to treat with conventional therapy. Patients with Darie’s disease are sometimes missed as nodular acne.

(4) Body Dysmorphic Disorder and Acne : A small number of patients with body dismorphic disorder have acne as their main symptom. Acne is usually mild and patients complain is out of proportion physical sign. Patients are depressed and have risk of suicide. They do not tolerate psycho therapy well. Dermatologists should treat acne vigorously with isotretinoin and minocycline.

(5) Drug Induced Acne: Many drugs have been implicated to cause acne. Evidence is through isolated case reports. The following drugs causes acne as side effect:

  • Halogens: Bromide, iodide, halothane .
  • Antitubercular drugs:Isoniazid, rifampicin.
  • Antiepileptic dregs: Phenytoin, phenobarbitone
  • Miscellaneous: Disulfirum, chloral hydrate, lithium, cyanecobalamine, psoralens, quinine, sulphur, thiouracil and thiourea.

Steroids induce cornification of the upper part of pilocebaceous duct. Androgens including anabolic steroids taken by athletes to enhance performance, can aggravate acne. Oral conntraceptive pills can also cause deterioration of preexisting acne as they reduce SHBG levels.

(6) Endocrine acne :This type of acne is seen in patients with endocrine disease like Cushing’s disease and polycystic ovarian syndrome(commonest cause of endocrine acne).

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