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.
(4) Pyoderma Faciale: Also known as rosacea fulminans. Though it is a variant of acne it is more related to rosasea. This is severe form of facial dermatosis. It is uncommon and occurs by suddenly producing eruptions of pustules and nodules, mainly in face. Common age group is 20-40 years of females, usually followed by stress; comedones are rare and there is no systemic involvement. Pyoderma faciale is reported to be associated with daily high dose of vitamin B complex and with Chron’s disease, but the cause of association is not known.
Treatment is with minocycline (100-200mg/day) and intra-lesional steroids. But the treatment of choice is oral isotretinoin 0.5mg/kg/day for 4-6 months. To reduce exacerbation oral prednisolone (0.5 to 1mg/kg/day) is used and tapered to zero over 4 weeks should be given. The prednisolone should be started 2-3 weeks before starting isotretinoin. Other alternative is metronidazole and dapsone.
(5) SAPHO syndrome: SAPHO is sinuvitis, acne, pustulosis, hyperostosis and osteitis. It is associated with recurrent chronic multifocal osteomyelitis which have skin disorders. Severe acne is one of the less frequently associated disorder. This may due to immunological reaction to a particular bacterial antigen.
(6) Vasculitis/pyoderma Gangresisum acne: This occurs in otherwise mild acne patients. There is sudden onset of severe vasculitic and pyoderma gangrenosum like lesions. There is severe scarring as a consequence. The cause of this devastating acne may be due to immunological reaction to P.acnes. These patients do not respond to isotretinoin but can be controlled to some extent by oral steroids and azathioprine (200mg/day) it given for 2-3 moths.
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