Acne

Baby Acne and Juvenile Acne

Infantile (baby acne) and juvenile acne mainly affects male babies of 3 to 24 months of age and may continue up to age of 5 years. The lesion are more localized and commonly affects cheeks. The lesions contain comedones, papules and pustules, and sometime it may include nodules and scarring also. Another disease which is almost same as acne is seen among infants in first 3 weeks of life called neonatal cephalic pustulosis. Here also papules and pustules are seen in cheeks. These are commonly due to Malassezia sympodiales. This is self limiting disease and need no treatment. But topical antifungal creams can be of help.

In one of the study on baby acne and juvenile acne, it was found that about one fourth of patients had mild acne, approximately 60% had moderate acne and remaining had severe acne and mean age of onset was 9 months of age.

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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.

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Acne: Severe Forms (The Other Four)

Here remaining four severe forms of acne are discussed:

(3) Gram-Negetive Folliculitis: This is a complication of long term antibiotic therapy for treatment of acne. Usually oral antibiotic are responsible and less commonly topical antibiotics. Common presentation is sudden eruption of multiple, follicular pustules (with pus ) or nodules. Examination of samplings reveals gram-negative organisms like klebsiella, proteas, Escherchia coli (e.coli) or pseudomonas. Treatment is stopping of antibiotics and replace them with ampicillin (250mg four times/day) or trimethoprime (600mg/day). But relapses are common and response is slow. So nowadays isotretinoin is the treatment of choice, with this relapses are less common.

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Severe Forms of Acne

There are mainly six severe forms of acne. They are (1) acne conglobata, (2) acne fulminans, (3) gram-negative folliculitis, (4) pyoderma faciale (also known rosasea fulminans), (5) SAPHA syndrome and (6) pyoderma gangrenosum acne.

The first two are discussed here:

(1) Acne conglobata: This is very uncommon but very severe form of acne. This is particularly seen in males and usually occurs in the trunk and upper limbs. Unlike common acne, facial lesions are less common in acne conglobata. This type of acne starts in early teens and increases in severity in second and third decade. This is characterized by multiple inflammatory papules and tender (painful) nodules. They frequently fuse together to form draining sinuses (sinus is a channel with opening outside). Large scaring and multiple blackheads are also seen. There may be malignant (cancerous) change in the scar. Rarely it is seen with folliculitis decalvans which is very rare and chronic progressive hair disease that produce scaring alopecia (baldness of head). There is extensive scaring. Familial cases of acne conglobata has been reported. It may persist up to the age of 40-50 years.

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Treatment of acne & Acne Scar

Acne can be a major problem in adolescence. Cause of acne is mainly due to four reasons namely excess sebum production (seborrhea), formation of comedones (comedogenesis), inflammation and presence of bacteria propinibacterium acnes.

Acne cream treatment is one of the best forms of treatment. It is used for treatment of acne. Acne creams can be of antibiotic to kill the causative bacteria of acne i.e. propinibacterium acnes or it may be of keratolytic property (peeling effect) like benzoyl peroxide. Benzoyl peroxide is mainly keratolytic, but it has some antibacterial property as well.

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Physiological & Environmental Factors That Influence Acne

The following are the physiological and environmental factors that may help or aggravate acne:

(1) Diet: A large number of foods are blamed for acne, like pork fat and chocolate, but there is no scientific proof. Chocolate have no influence on acne whatsoever, severe diet restriction reduces seborrhea, but this is not a routine treatment. Several studies have been done about diet and acne. A study was done in Papua New Guinea and Ache­ hunters in Paraguay and in the study not a single male or female was found with acne, and it was proposed that diet was responsible for that. But since the above populations live in close communities so genetic factors also must be important. The authors of the study suggested that western diet has a high glycemic index (diet rich in food which trigger insulin and insulin-like growth factor secretion). This induces seborrhea and comedones and acne. Acne also occurs less frequently in Japan, Zambia and Nigeria, where diets are different from that of western countries. But lower incidence of acne may be due to genetic and other environmental factors. There is a possible effect of nutrition on acne and this is seen during puberty, when there is higher chance of acne and body weight is about 48 kg at that time. The trend of increased body weight and early puberty has given rise to early appearance of acne.

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