DR Medhat MRCP

• Clinical presentation :
Blackheads (open comedones)
Whiteheads (closed comedones)
Inflamed papules,pustules & nodules of varying severity in face,back & upper chest
Scarring may be evident.
Post-inflammatory hyperpigmentation (brown/black skin)
Uncommon : Acne fulminans (severe inflammatory/cystic acne + ulcer +fever)
Acne conglobata (nodulocystic,sinuses,scars)
• Drug-induced acne Endocrine causes of acne :
1. Corticosteroids (oral & inhaled) 1. Polycystic ovary syndrome
2. Androgens & anabolic steroids. 2. Cushing syndrome
3. Phenytoin 3. Congenital adrenal hyperplasia
4. Lithium 4. Gonadal or androgen-secreting
5. Isiniazide tumor
• Treatment : (minocyclin is not used due to risk of irreversible pigmentation)
1 st line : topical retinoids or topical benzyl peroxide
2 nd line: topical retinoids + benzyl peroxide + topical antibiotic.
3 rd line : add oral antibiotics (tetracycline or erythromycin `in pregnancy`)
Severe acne with scarring (resistant to ttt) : oral isotretinoin.
• Prognosis :
- 90% clears by the age of 25. Psychological morbidity may occur if persist.
- Improvement may not be seen for 3-4 months of oral antibiotics.
- If G-ve folliculitis developed due to prolonged use of antibiotics treat by high
dose of trimethoprim.
- There is no role of diet modification in ttt of acne.
5