acne, acne variants, acneform eruptions, treatment of acne,

3. 1. Acne conglobata
2. Acne fulminans
3. Neonatal acne
4. Infantile acne
5. Post-adolescent
acne
6. Acne excoriée
7. Cosmetic / Pomade
acne
8. Acne Detergicans
9. Acne mechanica
10.Premenstrual Acne
11.Occupational acne
/ Chloracne
12.Senile (solar)
comedones
13.Drug-induced acne
14.Pyoderma Faciale
15.Solid facial edema

4.  Conglobate: shaped in a rounded mass or
ball
 Severe form of inflammatory nodulocystic
acne characterized by numerous comedones,
large abscesses or cysts interconnecting with
sinuses, grouped inflammatory nodules but
without systemic manifestations.
 Suppuration
 on forehead, cheeks, and neck

5.  Occurs most frequently
in young men
 Follicular Occlusion Tetrad:
I. Acne conglobata,
II. Hiradenitis suppurva,
III. Dissecting cellulitis of the scalp
IV. Pilonidal cysts
 Heals with scarring difficult to prevent
 Treatment; oral isotretinoin for 5 months

10.  The association of
1. Sterile Pyogenic Arthritis,
2. Pyoderma gangrenosum,
3. Acne conglobata
 can occur in the context of an autosomal
dominant autoinflammatory disorder
referred to as PAPA syndrome.

11.  the most severe form of
acne characterized by
sudden onset of severely
inflamed nodulocystic &
suppurative acne lesions
in association with systemic manifestations.
 Rare form of extremely severe Teenage
boys, chest, shoulders & back
 Patients typically have mild to moderate
acne prior to the onset of acne fulminans

12.  Rapid coalescence into painful, oozing,
friable plaques with hemorrhagic crusts
Rapid degeneration of nodules leaving
ulceration can lead to significant scarring.
 Fever, arthralgias, myalgias,
hepatosplenomegaly, severe malaise.
anorexia are common. Osteolytic bone
lesions may accompany the cutaneous
finding.
 Ix: leukocytosis, proteinuria

14.  Synovitis, Acne, Pustulosis,
Hyperostosis, and Osteomyelitis
 Acne fulminans, acne conglobata,
pustular psoriasis, and palmoplantar
pustulosis
 Chest wall is most site of
musculoskeletal complaints

15. Pustules on the sole of the left foot (A) and left palm (B),
and radioisotope scan (C) showing intense uptake by the
sternoclavicular and first sternocostal joints.

16. 1. Oral steroids
2. Oral isotretinoin often with initiation of the
latter at a low dose and/or after the acute
inflammation subsides.
3. Topical or intralesional corticosteroids,
4. Oral antibiotics (limited efficacy),
5. TNF-α inhibitors
6. Immunosuppressives (e.g. azathioprine).
7. Dapsone

17.  Postadolescent girls, reddish
cyanotic erythema with
abscesses and cysts
 Distinguished from acne by
absence of comedones, rapid
onset, fulminant course
and absence of acne on the
back and chest
 Tx; oral steroids followed
by isotretinoin

19.  very common First four weeks of life
 More than 20% of healthy newborns.
 Facial papules or pustules typically no
comedones.
 Arise primarily on the cheeks and nasal
bridge but the forehead, chin, neck and
upper trunk can also be involved.

21.  The development related to hormonal
activity in utero / An inflammatory response
to Malassezia spp. (e.g. furfur) has been
proposed as the etiology and will resolve
spontaneously 1-3 months after delivery
without evidence of scarring.
 No treatment is required except reassurance
for parents who may be extremely anxious
 Tx with topical imidazoles (e.g.
ketoconazole 2% cream).

22.  Cases that persist beyond 4 weeks or have
an onset after
 In contrast to neonatal acne, comedo
formation is prominent and pitted scarring
can develop.
 Infantile acne typically resolves within 1–2
years and remains quiescent until around
puberty. In unusual cases, however,
infantile-onset acne may persist into
adolescence.

23.  Androgen production intrinsic to this stage
of development including elevated levels of
LH stimulating testicular production of
testosterone in boys during the first 6–12
months of life (with levels transiently
equivalent to those during puberty) and
elevated levels of DHEA produced by the
infantile adrenal gland in both boys and
girls. These androgen levels normally
decrease substantially by 6-12 months of
age and remain at nadir levels until
adrenarche.

26.  Topical retinoids (e.g. tretinoin,
adapalene) and benzoyl peroxide are first-line
treatments.
 Oral antibiotics (e.g. erythromycin,
azithromycin) can be helpful for patients
with a more severe inflammatory
component,
 Isotretinoin is occasionally required for
recalcitrant or nodulocystic presentations

27.  Inflammatory acne persisting beyond 25
years of age is most common in women,
 Tends to flare during the week prior to
menstruation, and typically features tender,
deep-seated papulonodules on the lower
third of the face, jawline and neck.
 Approximately one-third of affected women
have other signs of hyperandrogenism
 Regardless of androgen levels, hormonal
therapy is often effective.

28.  Papulopustular lesions week prior
 Estrogen-dominant contraceptive pills
will diminish

29.  Girls, mild acne minute or
trivial primary lesions are
made worse by squeezing,
scratching, erosions and
crusting on individual lesions.
 Crusts, scarring, and atrophy
 Individuals with an anxiety
disorder, obsessive–
compulsive disorder or
personality disorder are
particularly at risk

31.  In addition to acne Rx;
 eliminate magnifying mirror,
 Rx of depression; Antidepressants or
psychotherapy

32.  Occurs secondary to repeated
mechanical and frictional
obstruction of the
pilosebaceous outlet.
 Well-described mechanical
factors include rubbing by
helmets, chin straps,
suspenders and collars.

33.  Fiddler’s neck, where
repetitive trauma from violin
placement on the lateral neck
results in a well-defined
lichenified, hyperpigmented
plaque interspersed with
comedones. Linear &
geometrically distributed areas
of involvement should suggest
acne mechanica.
 Treatment is aimed at
eliminating the inciting forces

35.  Patients wash face with comedogenic
soaps
 Closed comedones
 Tx; wash only once or twice a day
with non-comedogenic soap

36.  An unusual and disfiguring
complication of AV.
 Clinically, there is a
distortion of the midline
face& cheeks due to soft
tissue swelling.
 The woody induration may be accompanied by
erythema. Impaired lymphatic drainage and
fibrosis.
 Fluctuations in severity are common, but does
not usually resolve spontaneously.

37. 1. Isotretinoin (0.2–1 mg/kg/day),
alone or in combination with;
2. Ketotifen (1–2 mg/day) or;
3. Prednisone (10–30 mg/day), for 4–5
months.

38.  Rare, females 25-40 yrs
 Starts in spring, resolves by fall
 Small papules on cheeks, neck, upper body
 Comedones & pustules are sparse or absent
 Tx; retinoic acid, abx don’t help

39.  Exposure to insoluble, follicle-occluding
substances in the workplace.
 Comedones dominate the clinical picture, with
varying numbers of papules, pustules and cystic
lesions distributed in exposed as well as typically
covered areas.
 Offending agents:
1. Cutting oils
2. Petroleum-based products
3. Chlorinated aromatichydrocarbons (Chloracne)
4. Coal tar derivatives.

41.  Appear after prolonged
exposure to coal-tar
products coal tar oils,
 These compounds, forming
a black plug mixed with
dead skin cells and keratin.
 Especially the face and arms.
 If not treated properly, coal-tar acne can
develop into skin cancer

42.  Occupational acne caused by exposure to
chlorinated aromatic hydrocarbons,
develops after several weeks of exposure.
 The malar, retroauricular and mandibular
regions of the head and neck as well as the
axillae and scrotum, are most commonly
afflicted with small cystic papules and
nodules. The extremities, buttocks and
trunk are variably involved.

43.  Cystic lesions can heal with significant
scarring, and recurrent outbreaks may
occur for many years following exposure.
 Chloracnegens, found in electrical
conductors and insulators, insecticides,
fungicides, herbicides and wood
preservatives.
 Prevention of exposure is integral to the
safety of at-risk employees.

47.  Initial management is aimed at
vigorous removal of chemical agents
at the time of exposure.
 Topical or oral retinoids and oral
antibiotics may be beneficial
therapeutic interventions

48.  Closed comedones and papulopustules on
the chin and cheeks
 In areas of skin chronically exposed to
follicle-occluding cosmetics
 May take months to clear after stopping
cosmetic product

49.  Blacks, males, due to greases or oils
applied to hair.
 Favors forehead and temples

52.  Acneiform eruptions are dermatoses that
resemble acne vulgaris.
 Lesions may be papulopustular, nodular, or
cystic. While acne vulgaris typically consists
of comedones, acneiform eruptions (such as
acneiform drug eruptions) usually lack
comedones clinically.
 Location may be outside of the area in
which acne vulgaris occurs.
 Age outside the range typical of acne
vulgaris.

53.  Acnelike eruptions develop as a result of;
1.Infections.
2.Hormonal abnormalities.
3.Metabolic abnormalities.
4.Genetic disorders.
5.Drug reactions.

54. 1.Epidermal growth factor
receptor inhibitor-induced
papulopustular eruption
2.Tropical acne
3.Radiation acne
4.“Pseudoacne” of the
transverse nasal crease
5.Idiopathic facial aseptic
granuloma
6.Childhood flexural
comedones
7.Nevus comedonicus.
8.Eruptive hair cysts.
9.Tuberous sclerosis.
10.Chloracne.
11.Acneiform drug eruptions.
12.Steroid acne.
13.Amineptine acne.
14.Gram-negative folliculitis.
15.Eosinophilic pustular
folliculitis.
16.Pityrosporum folliculitis.
17.Coccidioidomycosis.
18.Secondary syphilis.
19.Sporotrichosis.
20.Rosacea.
21.Perioral dermatitis.
22.Senile (solar) comedones

55.  EGFR inhibitors used for the treatment of solid
tumors, including head and neck squamous cell
carcinoma and lung, colon and breast carcinoma.
 The incidence of acneiform eruptions due to EGFR
inhibitors is very high, e.g. up to 95% of patients
treated with panitumumab.
 Patients present with an eruption of monomorphous
follicular pustules and papules involving the face,
scalp and upper trunk, usually 1–3 weeks after
beginning treatment with an EGFR inhibitor.
 No comedonal lesions are seen either microscopically
or clinically,

56. Acneiform eruptions due to epidermal growth
factor receptor inhibitors. A,B Numerous
monomorphous follicular pustules and crusted
papules on the face of two patients treated with
erlotinib

57.  Follicular acneiform eruption that results from
exposure to extreme heat.
 Markedly inflamed nodular, cystic, and
pustular lesions on back, buttocks, & thighs
 Face is spared
 Young adult military
stationed in tropics,
furnace workers.
 Tx; returns to a more
moderate climate.

58.  Characterized by comedo-like papules
occurring at sites of previous exposure to
therapeutic ionizing radiation.
 The lesions begin to appear as the acute
phase of radiation dermatitis starts to resolve.
 The ionizing rays induce epithelial
metaplasia within the follicle  adherent
hyperkeratotic plugs that are resistant to
expression.

59.  The transverse nasal crease is a horizontal anatomical
demarcation line found in the lower third of the nose
which corresponds to the
separation point between
the alar cartilage and the
triangular cartilage.
 Milia, cysts & comedones
can line up along this fold.
 These acne-like lesions
aren’t hormonally responsive
& arise during early childhood prior to puberty.
 Tx; consists of surgical expression as needed.

60.  chronic, painless, usually
solitary nodule with an
acneiform appearance can
develop on the cheeks of
young children.
 Histopathologic evaluation
reveals a granulomatous
inflammatory response; dermal
lymphohistiocytic infiltrate with
foreign body-type giant cells.
 They eventually resolve
spontaneously after an average
of 11 months without treatment

61.  Discrete, double-orifice comedones
localized to the axillae & less
commonly, the groin.
 The majority of patients have a single
lesion and the average age at Dx is 6
years.
 A small subset of cases are familial.
 In most cases, the flexural comedones
are discovered incidentally in patients
presenting with other dermatologic
concerns.

62. From: Childhood Flexural Comedones: A New Entity
Arch Dermatol. 2007;143(7):909-911. doi:10.1001/archderm.143.7.909
The left axilla showing 3 double-orifice comedones in a 4-year-old boy.
Date of download: 9/2/2014
Copyright © 2014 American Medical
Association. All rights reserved.
Figure Legend:

63. From: Childhood Flexural Comedones: A New Entity
Arch Dermatol. 2007;143(7):909-911. doi:10.1001/archderm.143.7.909
Axillary double-orifice comedo with a visible content underlying the epidermal bridge in an 8-year-old boy.
Date of download: 9/2/2014
Copyright © 2014 American Medical
Association. All rights reserved.
Figure Legend:

64.  Occurs in prolonged treatment with
antibiotics for acne vulgaris or rosacea.
 E. coli, Enterobactor, Klebsiella, Proteus.
 Anterior nares colonized
 Persistent papulopustular eruption,
 These gram-negative organisms are
typically spread to the skin of the upper
lip, chin, and jawline.
 Tx; isotretinoin is considered standard of
care.

66.  Papulopustules with erythematous base
 Characteristically; Clear zone around vermillion
border. It may also include the perinasal and
periorbital areas (periocular dermatitis).
 Young ♀ (23-35yrs)
 Has a superficial resemblance to rosacea

68.  Etiology;
1. Topical steroids
2. Demodex mites
3. Contact irritants or allergens
4. Moisturizers
5. Cleansers
6. Fluorinated compounds e.g. fluorinated
toothpaste
 Tx; d/c topical steroids or other offending agent
- oral tetracycline 1g/d or doxycycline
- topical pimecrolimus cream,
- azelaic acid

69.  An abrupt, monomorphous eruption of
inflammatory papules and pustules

70.  High-dose IV or oral corticosteroids commonly
induce characteristic acneiform eruptions with a
concentration of lesions on the chest and back
 Steroid-induced acne (and rosacea) can also
result from the inappropriate use of topical
corticosteroids on the face. Inflamed papules and
pustules develop on a background of erythema
that favors the distribution of corticosteroid
application.
 Lesions eventually resolve following
discontinuation of the steroid, although “steroid
dependency” can lead to prolonged & severe
flares post-withdrawal

72. 1. Anabolic steroids (danazol, testosterone)
2. Bromides
3. Corticosteroids
4. Corticotropin
5. EGFR inhibitors
6. Iodides
7. Isoniazid
8. Lithium
9. Phenytoin
10.Progestins

73. 1. Azathioprine
2. Barbiturates
3. Disulfiram
4. Halogens, other
5. Cyclosporine
6. Vitamins B2,6,12
7. Psoralen + ultraviolet A (PUVA)

74.  Itchy, acne-like eruption and
most often affects the trunk.
 Tiny dome-shaped pink papules
and small superficial pustules
arise in crops on the upper back,
shoulders & chest. It can
occasionally affect other areas
including neck, face & upper
arms.
 The spots may appear more
prominent when scratched.
 A KOH preparation of follicular
contents reveals abundant yeast
forms.

75.  AGGRAVATING FACTORS;
I. External factors
1. Hot, humid, sweaty environment  yeast overgrowth
2. Wearing occlusive clothing.
3. Sunscreens and greasy emollients.
II. Host factors
6. Immune deficiency.
1. Oily skin.
7. Medications, such as: Broad
2. Obesity.
3. Pregnancy.
4. Stress or fatigue.
5. Diabetes mellitus.
spectrum oral antibiotics, which
suppress skin bacteria allowing
yeasts to proliferate. Oral
steroids (steroid acne) OCP.
 Tx; 1. Correct as far as possible any of the
predisposing factors
2. Treat yeast overgrowth (like PVC)
3. Isotretinoin

76.  Arise on the face of the middle-aged
and elderly. They affect areas
that have been exposed to sunlight
over a long period of time,
particularly the cheeks, which may
become yellow and leathery
(solar elastosis).
 Occur in 6% of adults older than
50 years especially males.
 The comedones may be open or
closed may also be larger cysts.
 Solar comedones are not related to
acne vulgaris and do not usually
become inflamed. They are
however very persistent.

77.  Favre-Racouchot syndrome; usually bilaterally
symmetrical, Solar comedones in association with
elastosis (yellowish thickening and furrows)
atrophy, wrinkles. It may affect the skin around the
eyes, the temples and rarely the neck. It is thought
to be due to a combination of sun exposure and
heavy smoking.

78.  Medical:
1. Use sun protection and
apply oil-free sunscreen
to exposed skin
2. Stop smoking
3. Wash affected areas
twice daily with mild
soap or cleanser and
water
4. Apply retinoid cream to
affected areas at night
5. Apply light moisturisers
if the skin is dry
 Surgical: require further
treatment from time to
time.
1. Comedo extraction.
If these measures are
unhelpful, the comedones
can often be removed by:
2. Cautery, diathermy,
3. Chemical peels
4. Dermabrasion
5. Laser (CO2)

85. 1. To prevent the formation of new lesions.
2. To heal existing lesions.
3. To prevent or minimize scarring.
4. Decrease psychological stress.

86.  The clinical subtype, severity, prior treatment,
psychological impact, and presence of scarring
should be considered for all patients with acne.
 The treatment of acne usually involves initial
therapy followed by long-term maintenance therapy.
 Treatment should target as many pathophysiological
causes as possible.
 Use of topical or systemic antibiotic monotherapy
may give rise to antibiotic-resistance which may
leads to acne treatment failure & colonizing bacteria
on skin and at remote sites, including streptococcal
colonization of the throat.

87.  Use of combination therapy is more effective for the
treatment of acne.
 Topical retinoids used alone or as part of a
combination therapy is considered first-line in the
initial treatment and maintenance of all types of
acne except for severe nodular disease, which
requires systemic retinoid therapy.
 Severe disease–especially scarring or trunk
involvement–requires systemic therapy.
 Some female patients may benefit greatly from
hormonally targeted treatment.
 It is essential to align the treatment regimen with
the patient’’s goals and preferences for treatment:
systemic versus topical, complexity of regimen.

91. Topical Treatments Systemic therapy
1. Benzoyl peroxide
2. Retinoids
3. Antibiotics
– Clindamycin
– Erythromycin
– Sodium sulfacetamide/sulfur
4. Azelaic acid
5. Salicylic acid
6. Topical Dapsone
1. Oral minocycline
2. Oral doxycycline
3. Oral tetracycline
4. Oral erythromycin
5. Oral azithromycin
6. Oral Clindamycin
7. Oral Sulfanomides
8. Oral contraceptives
9. Oral spironolactone
10.Oral isotretinoin

93. 1. Benzoyl peroxide
2. Topical retinoids
3. Topical antibacterials
4. Azelaic acid
5. Sodium sulfacetamide
6. Salicyclic acid
7. Topical dapsone

94.  Available as gels, creams, lotions,
foams, washes, pads and soaps
alone as well as in combination.
 2.5% to 10%.
 Potent antibacterial effect also has
mild comedolytic properties
 Is to introduce oxygen to the clogged parts of the
skin pores  more oxygen is more fatal
environment for the anaerobic bacteria.
 Microbial resistance to benzoyl peroxide has not
been reported.

95.  It is on the World Health
Organization's List of
Essential Medicines, a list of
the most important
medication needed in a
basic health system.
 Contact dermatitis (irritant
> allergic)  frequency of
application.
 Whitening of clothing and
bedding

96.  Creams, gels, liquids
 0.01%, 0.025%, 0.04%, 0.05%
and 0.1%
 Cream base may be less
irritaiting
 1st-line therapy for mild to
moderate inflammatory acne ,
comedonal acne, maintenance
therapy, enhance penetration of
other drugs.

97.  MOA;
1. Normalize follicular keratinization
2. Comedolytic  the numbers of microcomedones,
comedones & inflammatory lesions.
3.  FFA in the microcomedons.
4. Anti-inflammatory; downregulating of TLR, cytokines
5.  penetration of the other medications into the
sebaceous follicle.
6. It reduces the signs of aging by stimulating collagen
production.
7. Tretinoin also may help prevent more serious effects
of ultraviolet radiation

99.  Tretinoin is photolabile so night-time application
is recommended to prevent early degradation.
 Adapalene to have milder comedolytic
properties than tretinoin, it is also less irritating
& unlike tretinoin, it is light-stable and resistant
to oxidation by benzoyl peroxide.
 Tazarotene synthetic retinoid, once applied, is
converted into its active metabolite, tazarotenic
acid. Both daily overnight application of
tazarotene and short contact therapy regimens
have been used and shown to be effective in the
treatment of comedonal and inflammatory acne.

100.  Side effects;
1.Local irritation
2.Erythema,
3.Dryness,
4.Peeling
5.Scaling.
6.Pustular flare of acne occasionally occurs
during the initial 3–4 weeks of Tx
7. pt.’s susceptibility to sunburn.

101.  For their role against P. acnes.
 creams and gels to solutions and
pledgets
 Erythromycin 2-3%
 Clindamycin 1% effective
against pustules and small
papulopustular lesions
 Both equally effective, combined
with bezoyl peroxide can
decrease resistance

102.  Naturally occurring
compound found in cereal grains.
 Cream and gel-twice daily.
 Anti-inflammatory/ Inhibiting the
growth of P. acnes/comedolytic
 low adverse reactions than topical
retinoids.
 In addition, it may help to lighten
postinflammatory hyperpigmentation.

103.  is a well-tolerated topical antibiotic
that is thought to restrict the growth
of P. acnes.
 It is formulated in a 10% lotion,
suspension, foam and cleanser, either
alone or in combination with 5%
sulfur.
 Tinted formulations are also available.

104.  Comedolytic and mild anti-inflammatory
agent.
 It is also a mild chemical irritant that works
in part by drying up active lesions.
 Available over the counter in concentrations
of up to 2% in numerous delivery
formulations, including gels, creams,
lotions, foams, solutions and washes.
 Side effects; include erythema and
scaling.

105.  Gel 5% is effective and safe as
monotherapy and in combination with
other topical agents in mild-to-moderate
acne vulgaris, direct
inhibition of leukocyte.
 Of note, a temporary yellow–orange
staining of the skin and hair
occasionally occurs with concomitant
use of topical dapsone and BPO.

107.  Use for 6m. or until lesions resolve.
 MOA;
1. Antimicrobial against P. acnes.
2.  chemotaxis of polymorphonuclear
leukocytes.
3.  lipase production in P. acnes.

108.  Tetracycline since 1951
 Safest and cheapest choice & good first
choice
 250 to 500mg QD to QID for 4 weeks or
until lesions respond.
 Gradual reduction in dose
 Take on empty stomach
 Calcium and iron decrease absorption
 Constant or intermittent tx months to years

109.  Tetracycline as sole treatment will give a
positive response in 70%
 May take 4-6 weeks for response
 Effects of tetracycline are obtained by the
reduction of FFA
 Vaginitis and perianal itching in 5% due to
Candida albicans
 Staining of growing teeth precludes use in
pregnancy and children < 9 or 10 y.

110.  100-200mg/d
 P. ances resistant
to erythromycin,
photosensitivity can
occur
 Gastro-Intestinal
adverse effects

111. Photosensitivity from doxycycline

112.  More effective than
tetracycline in AV.
 Lipophilic derivative of
tetracycline, greater
penetration into the
sebaceous follicle.
 50 to 100mg QD or BID
 Absorption less affected by
milk and food
 SE; minocycline-induced hypersensitivity
syndrome and autoimmune reactions.

114.  Erythromycin;
500mg t.i.d.
 Azithromycin;
250-500mg/d for
3days
 consider in young
and pregnant who
cannot use
tetracycline.

115.  150-300mg t.i.d
 works well, but can
cause
pseudomembranous
colitis

116.  Trimethoprim/Sulfamethoxazole
 SE; Phototoxicity, drug reactions, BM
suppression, Scalded skin

117.  Worsening clinical condition correlates
with a high minimum inhibitory
concentration for erythromycin and
tetracycline for P. acnes
 Resistance lost after 2 months after
withdrawal of antibiotic.
 Avoid use of different oral and topical
antibiotics at the same time

118.  Hormonal therapy is an established second-line
treatment for female patients with acne.
 work best in adult women with premenstrual
acne.
 Block both ovarian and adrenal production of
androgens
 Hormonal therapy include;
1. Oral contraceptives
2. Cyproterone acetate (CPA)
3. Oral spironolactone

119.  Estradiol suppresses the uptake of testosterone by
the sebaceous glands
 Oral contraceptives containing androgenic
progesterones may exacerbate acne.
 Three oral contraceptives are currently FDA-approved
for the treatment of acne, (Ortho Tri-cyclen,
Estrostep, Yaz, Loryna and Beyaz)
 Clinical data to support use Yasmin & Diane-35.
 From 5th to 25th day of menstruation.

120. Yasmin (Ethinyl estradiol 30/drospirenone 3000)
Drospirenone is an analog of spironolactone
(equivalent to 25 mg) and has antiandrogenic
and antimineralocorticoid properties.

121. Diane-35 (Ethinyl estradiol
35/cyproterone acetate 2000)

122.  Side effects;
1. Nausea,
2. Vomiting,
3. Abnormal menses,
4. Weight gain
5. Breast tenderness.
6. Hypertension
7. Thromboembolism (e.g. deep venous
thrombosis, pulmonary embolism).
8. Hepatotoxicity

123.  Progestational antiandrogen.
 Alone orin combinationwithEED.
 Anti-acne effects are mediated
primarily through androgen
receptor blockade.
 50–100 mg daily higher doses
may be helpful in ♀ with severe hyperandrogenism.
 SE; 1. inhibition of ovulation & spermatogenesis
2. Wt. gain
3. Congenital deformities in male fetus.

124.  synthetic corticosteroid
 Initiated with a low dose
(25–50 mg/day)
to  Side effects.
Effective maintenance
doses range from
25 to 200 mg/day
divided into 2 doses.
 Antiandrogenic; androgen receptor blocker
and an inhibitor of 5α-reductase.
 for severe inflammatory acne

125.  Side effects; are dose-related and
include;
1. Potential hyperkalemia rare in young
healthy patients.
2. Irregular menstrual periods.
3. Breast tenderness.
4. Headache.
5. Fatigue.
6. Risk of feminization of a male fetus.

126.  A systemic retinoid
 0.5 to 1 mg/kg/day
qd or bid for 15 to 20 wks
(taken with a fatty meal
to  gastrointestinal
absorption)
 Total cumulative dose is 120-150
mg/kg to reduce the risk of relapse.
 Leads to a remission that may last
months to years

127.  Retinoids exert their physiologic effects
through two distinct families of nuclear
receptors; RARs and retinoid X
receptors (RXRs).
 Systemic retinoids act as:
1. Comedolytic
2.  follicular keritization
3. Anti-inflammatory
4. Suppress sebum production
5. Indirectly antimicrobial

128.  FOR PATIENTS WITH ACNE;
1. Nodular or nodulocystic acne
2. Acne conglobata
3. Acne fulminans
4. Severe disfiguring inflammatory acne vulgaris
5. Acne which is resulting in scarring
6. Moderate acne which has failed to respond to topical
agents with oral Abc, or in ♀, hormonal Tx.
7. Acne which relapses rapidly on discontinuing Tx.
8. Acne which has persisted for several years, or arises
in an individual over 25 years old
9. When the acne has a significant adverse
occupational, social or psychological effect.

129.  FOR PATIENTS SEVERELY AFFECTED BY OTHER
FOLLICULAR CONDITIONS. THESE INCLUDE:
1. Acne keloidalis nuchae
2. Occupational acne/Chloracne
3. Gram negative folliculitis
4. Hidradenitis suppurativa
5. Pityrosporum folliculitis
6. Pseudofolliculitis barbae
7. Pyoderma faciale
8. Solid facial edema
9. Rosacea and rhinophyma
10. Scalp folliculitis
11. Sebaceous hyperplasia
12. Seborrhoea
13. Steatocystoma multiplex

130.  TREATMENT FOR SCALY AND OTHER
INFLAMMATORY SKIN CONDITIONS:
1. Darier disease
2. Discoid lupus erythematosus (DLE)
3. Epidermal naevi
4. Folliculitis decalvans
5. Granuloma annulare
6. Grover disease
7. Ichthyosis
8. Sarcoidosis
9. Skin cancers especially when they arise in
those with organ transplants or xeroderma
pigmentosa

131.  Nasal colonization with S.aureus in 90%
 Paradoxical worsening of acne commonly
occur, an acne fulminans-like flare
occasionally develops during the first few
weeks of isotretinoin therapy for acne.

132.  Most patients are advised to have blood tests before
and four weeks after treatment begins or more
occasions during isotretinoin treatment.
1.Pregnancy test (beta-HCG) for women and girls
of child-bearing potential.
2.Lipid profile (cholesterol & triglyceride levels).
3.Liver function tests. Occasionally, isotretinoin
may disturb liver function; this requires monitoring
but if the reaction is mild the drug can usually be
continued. Rarely, it causes a symptomatic
hepatitis: the drug must then be discontinued.
4. Blood count: this is to check for anaemia and to
monitor white cell count and platelets.

133. 1-Dryness of skin, conjunctiva and mucosa of the
genitals, chapped lips (cheilitis), dry Eyes, Epistaxis
2- Arthralgias, myalgias
3- Mood changes, Depression &
suicidal behavior
4- Elevated lipids (serum triglyceride)
5- Hepatotoxicity
6- Abortion or Teratogenicity
7- Nails dystrophy, paronychia,
palmoplantar desquamation,
8- Pseudotumor cerebri (benign intracranial HTN)
9- Fulminans-like flare,
10- Pyogenic granuloma
11- Premature epiphyseal closure in children < 13 y.

136.  Women of childbearing age are
urged to use 2 methods of
contraception for 1 month
before treatment, during
treatment and at least 1
month after stopping
treatment.
 Pregnancy test should be done
before beginning therapy and
monthly until therapy stops.

137. Drug interaction with isotretinoin
Tetracyclines
Vitamin-A & its
derivatives

139. LESIONS SCARS
1. Extraction of comedones
2. Drainage of pustules and
cysts
3. Intralesional injection of
corticosteroids in nodules
& cysts
4. Excision and unroofing of
sinus tracts and cysts
1. Dermabrasion
2. Laser abrasion
3. Chemical peels
4. Injection of filling
materials
5. Excision
6. Punch autografts

140.  Comedone extractor brings about
quick resolution of comedones
improve cosmetic appearance
Especially beneficial for deep,
inspissated and persistent
comedon
 In Isotretinoin pts
macrocomedones present at
week 10 to 15 of therapy
 Nicking the surface of a closed
comedo with an 18-gauge needle
or a #11 blade allows easier
expression.

141.  Effective in reducing inflammatory papules,
pustules, & smaller cysts & nodule
 Acne conglobata & acne fulminans
 Kenalog-10 (triamcinolone 10mg/ml)
 Diluted with NS to 5 or 2.5mg/ml
 The maximal amount used per lesion
should not exceed 0.1 ml.
 The risks of corticosteroid injections;
1. Hypopigmentation
2. Atrophy,
3. Telangiectasias,
4. Needle tract scarring.

142.  Low-concentration are beneficial
for the reduction of comedones.
 The α-hydroxy acids (including
glycolic acid), salicylic acid and
trichloroacetic acid are the most
common peeling agents.
 These lipid-soluble comedolytic
agents act by  corneocyte
cohesion at the follicular opening
and assist in plug extrusion.
 Risks of chemical peels include;
1. irritation,
2. pigmentary alteration
3. scarring.

144.  Red, Green, or Blue light: inflammatory acne
,absorbed by P. acnes porphyrins.
 IPL: trigger the destruction of the P. acnes.
 PDT (photodynamic therapy) using ALA :
induces partial destruction of the sebaceous
glands along with the destruction of P. acnes.
 Lasers: pulsed dye, the 1320 nm
neodymium:YAG and especially the 1450 nm
diode may be of therapeutic benefit for
inflammatory acne
 Acne vaccine
 Metformin

146. 1. Microdermabrasion/Dermabrasion
2. Laser abrasion
3. Subcision
4. Punch autografts
5. Injection of filling materials
6. Chemical peels
7. Dermaroller
8. Full thickness surgical excision

148. a) CO2 laser
b) Erbium-Yag laser.

149.  commonly used
technique in the
management of acne
scars.

150. Is an option for patients with
“ice-pick” scarring.

151. For discrete depressed scars
can be temporarily
beneficial.
Filler substances used
include;
1. Hyaluronic acid,
2. Poly-l-lactic acid,
3. Calcium hydroxylapatite
4. Autologous fat.

153.  Dermaroller is a
cylindrical shaped drum
with very fine needles.
 It is a medical device
used to stimulate skin
cells to proliferate.
 NEEDLE LENGTH: 1-2mm

154.  For;
1. Larger hypertrophic scars,
2. Aggregated pitted scars
3. Sinus tracts.

155. References
 Jessica San Juan Microbiology
 Prof. Dr. Wafaa Afify
 Bolognia 3rd ed.