Psychosocial impact of acne and postinflammatory hyperpigmentation

Abstract: Background: Acne is one of the most common skin diseases. It has significant effect on self-image and negative impact on quality of life. Postinflammatory hyperpigmentation is an acquired hypermelanosis that occurs after a skin injury or cutaneous inflammation. It is common sequelae in acne patients. Objectives: This study aimed to investigate the psychosocial impact of acne and postinflammatory hyperpigmentation among patients treated in a dermatology outpatient clinic at the University of Miami Hospital. Methods: The study had the participation of 50 patients with acne and postinflammatory hyperpigmentation. All participants volunteered to complete an anonymous questionnaire containing socio-demographical information, questions about patient's attitudes toward postinflammatory hyperpigmentation caused by acne, the Cardiff Acne Disability Index and the Dermatology Life Quality Index. Results: Postinflammatory hyperpigmentation was more predominant in the face. Makeup was frequently used to conceal the imperfections and the majority of patients felt embarrassed due to their condition. Interestingly, the majority of our patients did not have their quality of life impacted for acne and postinflammatory hyperpigmentation. Study limitations: A limitation of the study was the relatively small sample size. For this reason, the findings of the study should not be generalized to the broader community. Conclusion: The current medical literature has many studies analyzing the psychological impact of acne. This study is the first study in the literature that analyzed the psychosocial impact of acne and postinflammatory hyperpigmentation caused by acne.

Acne fulminans

Abstract: Acne fulminans is a rare and severe variant of acne. In Brazilian medical journals, cases are infrequently reported, confirming its rarity. We followed five young male patients with this severe variant of cutaneous lesions, accompanied by also severe systemic symptoms: fever, anorexia, weight loss, and arthralgia. All had a good response to corticosteroids (prednisone), but had significant scarring.

Acne scars in 18-year-old male adolescents: a population-based study of prevalence and associated factors

Abstract: Background: Acne vulgaris is a pilosebaceous follicle disorder affecting over 85% of adolescents to some degree. It frequently causes psychological distress that may persist into adulthood due to scarring. Little information about post-acne scarring epidemiology is available. Objectives: To describe prevalence, distribution patterns and associated factors of acne scarring in young males, drawing on a representative population sample from a southern Brazilian city. Methods: A cross-sectional study was undertaken during presentation for military service, which is compulsory for all 18-year-old males. A questionnaire was applied, covering topics like diet, smoking habits, ethnicity, family structure, socio-economic level, as well as specific questions about active acne and resulting scars. Dermatologists conducted the clinical examination. Results: A total of 2,201 male adolescents were interviewed and examined. The overall prevalence of acne scarring was 22%. The malar region was the most frequently involved, present in 80% of affected individuals, followed by the frontal region (31.5%), back (17%), anterior chest (8.2%) and mentonian region (6.4%). Correlation between the intensity of clinical acne and the presence of scars was found, but no association was observed with educational level, smoking, ethnicity, obesity or socio-economic status. Conclusions: There is a high prevalence of acne scars among this population. This is the first study to ascertain a correlation between acne scarring and factors such as socio-economic status and educational level. The direct relation between acne severity and scarring indicates that prompt and effective treatment is the best way to reduce scarring.

Técnicas quirúrgicas y láser en cicatrices atróficas de acné / Surgical and laser techniques in atrophic acne scars

Las cicatrices de acné, especialmente las de tipo atrófico, constituyen una complicación frecuente del acné vulgar que se asocia a un importante impacto psicológico. Múltiples terapias se han utilizado para mejorar su aspecto, sin embargo, ninguna ha demostrado ser completamente eficaz y segura. El tratamiento quirúrgico en acné cicatricial incluye técnicas como escisión elíptica, escisión o elevación por punch, subcisión y distintos tipos de láser. El objetivo de esta revisión es presentar la evidencia disponible respecto a las técnicas quirúrgicas y dispositivos láser utilizados en cicatrices atróficas de acné.

Acne scars, especially the atrophic type, are a common complication of acne vulgaris, which is associated with a major psychological impact. Multiple therapies have been used to improve its appearance, however, none has proven completely effective and safe. Surgical treatment includes surgical techniques such as elliptical excision, punch excision or elevation, subcision and different types of lasers. The aim of this review is to present the available evidence regarding the surgical techniques and laser devices used in atrophic acne scars.

Satisfacción de pacientes con cicatrices atróficas de acné tratados con láser ablativo y/o técnicas quirúrgicas / Satisfaction of patients with atrophic acne scars treated with ablative laser and / or surgical techniques

Las cicatrices atróficas constituyen una complicación frecuente del acné vulgar. Existen múltiples tratamientos quirúrgicos, aunque ninguno ha demostrado ser satisfactorio. Se realizó un estudio transversal retrospectivo de 47 pacientes con cicatrices atróficas de acné intervenidos mediante Cirugía Punch (CP) y/o Láser CO2 10.600 nm (LCO), a quienes se aplicó un cuestionario validado entre Abril y Septiembre de 2014. El 63,8 por ciento recibió tratamiento solo con LCO, el 10,6 por ciento solo con CP y el 25,6 por ciento recibió ambos tratamientos. Respecto al grado de satisfacción, el 9 por ciento refirió un puntaje de 10 luego del procedimiento, el 32 por ciento entre 7-9, el 43 por ciento entre 4-6 y un 17 por ciento entre 0-3. El 66 por ciento de los pacientes refirió que los efectos se mantienen en el tiempo y el 21 por ciento reportó efectos adversos. El tratamiento quirúrgico de las cicatrices atróficas de acné con técnicas como CP y/o LCO consigue grados de satisfacción moderados, con efectos mantenidos a largo plazo y escasos efectos adversos.

Atrophic scars are a common complication of acne vulgaris. There are multiple surgical treatments, but none have proved satisfactory. A retrospective cross-sectional study of 47 patients with atrophic acne scars surgery was performed by Punch Surgery (CP) and / or CO2 Laser 10,600 nm (LCO), a validated questionnaire between April and September 2014 was applied. 63.8 percent received only LCO treatment, only 10.6 percent CP and 25.6 percent received both treatments. Regarding the degree of satisfaction, 9 percent reported a score of 10 after the procedure, 32 percent between 7-9, 43 percent between 4-6 and 17 percent 0-3. 66 percent of patients reported that the effects are maintained over time, and 21 percent reported adverse effects. Surgical treatment of atrophic acne scars with techniques such as CP and / or LCO achieved moderate degree of satisfaction with maintained long-term effects and few adverse effects.

Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study

BACKGROUND: Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard OBJECTIVE: To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne. METHODS: A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression. RESULTS: We included 158 patients (66% women), with a median age of 23±11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01). CONCLUSION: The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults. .

Acné fulminans: presentación de un caso / Acne fulminans: case review

Introducción: El acné fulminans fué descrito en 1959 y se considera una forma aguda y grave de acné, originalmente se denominó como acné colglobata ulcerativo febril agudo, la principal característica es el inicio súbito de las lesiones. Los hayazgos clínicos incluyen acné ulcero-costroso, fiebre, poliartritis, anormalidades en las pruebas de laboratorio y escasa respuesta al tratamiento antimicrobiano. afecta principalmente a adolescentes varones, pero tambien puede presentarse en mujeres; las lesiones son mas frecuentes en tórax y se han reportado pocos casos de localización facial o ambos. El tratamiento de elección son los corticoides orales y la isotretinoína oral. Presentación de caso: Se trata de paciente femenino de 19 años de edad que debuta súbitamente con placas costrosas supurativas, nódulos y quistes que forman trayectos localizados en cara. Acompañando al cuadro fiebre, mal estado general y altralgias; ademas con leucocitosis y aumento de la velocidad de eritrosedimentación. Se manejo con antibióticos sistémicos, esteroides y posteriormente con isotretinoína oral, con resolución del cuadro. Conclusión: El acné fulminans es una entidad poco frecuente, su diagnostico es fundamentalmente clínico y su manejo debe ser oportuno para evitar secuelas. Esta rara enfermedad responde pobremente a los antibióticos de amplio espectro, a los antiinflamatorios no esteroideos y al tratamiento tópico convencional del acné vulgar. El tratamiento de elección son los corticosteroides orales y la isotretinoína, lo cual demostramos con la presentación de este caso clínico...

Lesões múltiplas de osteoma cutis na face: terapêutica minimamente invasiva em pacientes com sequela de acne - relato de casos / Multiple injuries of osteoma skin in the face: therapeutical least invasive in patients with acne sequela - case report

Osteoma cutis é a formação óssea no interior da pele, podendo ser primária ou secundária. Única ou múltipla, de tamanhos variados e acometendo ambos os sexos, é uma lesão cutânea rara, de etiopatogenia e classificação ainda discutidas. Nosso objetivo foi relatar o diagnóstico e a terapêutica minimamente invasiva de lesões múltiplas de osteoma cutis na face em pacientes com sequelas de acne. Fizemos a retirada dos osteomas com agulhas BD 0,70 x 25 22G1, sem anestésicos tópicos ou injetáveis no local. As pequenas incisões foram deixadas expostas, com pomada cicatrizante. Obteve-se um excelente resultado estético em 15 dias.

Osteoma cutis is a bone formation in the dermis can to be primary or secondary forms. Only, multiples, many forms, occurring on either sex, they are a rare cutaneous disease. The pathogenesis and classification remains unclear. Our objective was the diagnostic and small invasive surgery treatment of the osteoma cutis multiple of the face, in patients as a sequel of acne. To remove the osteoma we used needle BD 0,70x25 22G1, without anesthetic topic or inject able site. The small wounds were exposed with scarring balsam. We got an excellent esthetic result after 15 days.

Prevalence of polycystic ovary syndrome in women with acne: hormone profiles and clinical findings

Polycystic ovary syndrome [PCOS] is the most common endocrine disorder and is the leading cause of hyperandrogenemia in women. Acne vulgaris is also a common cutaneous manifestation of hyperandrogenism. To determine the prevalence of PCOS in patients with acne and its associated factors with regard to the clinical and paraclinical findings. In this cross-sectional study, 118 women with acne referred to various clinics of dermatology were enrolled. A clinical examination was followed by a laboratory examination, including hormone profile and ovarian sonography. Confirmation of PCOS was based on the diagnostic criteria of the National Institute of Health [NIH] and the sonographic findings. The subjects were 14-38 years old. PCOS was diagnosed in 57 [48.3%] patients by sonography methods, while, 71 [60.2%] patients were diagnosed as PCOS cases based on the NIH criteria. Around 54% of the patients complained of hirsutism and 37% of them suffered from menstrual disturbances. PCOS versus non-PCOS had profiles of prolactin [19.36 +/- 11.96 ng/ml vs. 17.31 +/- 9.29 ng/ml], testosterone [0.80 +/- 0.57 pg/ml vs. 0.93 +/- 0.98 pg/ml], and dehydroepiandrosterone levels [2.48 +/- 1.98 microg/dl vs. 1.97 +/- 1.02 microg/dl], which were not statistically different [p>0.05]. The luteinizing hormone to follicular stimulating hormone ratio was significantly higher in PCOS [p=0.01]. According to the findings of this study, PCOS is a common disorder among women with acne. Although PCOS was expected to correspond with a specific hormonal profile, our study showed that most of the PCOS patients had normal levels of tested hormones. Therefore, we recommend that sonographic evaluation be one of the core examinations in the diagnosis of PCOS in women having acne

Late onset isotretinoin resistant acne conglobata in a patient with acromegaly.

A 55 year-old male presented with multiple pus-discharging abscesses and sinuses and mutilating scarring on the gluteal region and back prevalent for the last ten years with exacerbations and remissions. Physical examination revealed acromegaly with frontal bossing, prognathism, a barrel chest and acral hypertrophy. Dermatological examination revealed cutis verticis gyrata, thick eyelids, a large triangular nose, a thickened lower lip, macroglossia, widely spaced teeth and widened skin pores with wet and oily skin. Hair was fine and nails were flat and wide. There were multiple inflammatory papules, tender nodules, draining sinuses, and grouped, polyporous comedones as well as multiple and extensive depressed and keloidal scars localized predominantly over the gluteal region with a few scattered lesions over the back. A computed tomography (CT) scan showed widened sella turcica. His basal fasting growth hormone (GH) levels were markedly raised (230 ng/mL; normal 1-5 ng/mL) while the prolactin levels were moderately raised (87 ng/mL; normal 2-5 ng/mL). These findings were consistent with a diagnosis of acromegaly. The patient was put on antibiotics, nonsteroidal antiinflammatory drugs and isotretinoin at a dose of 1 mg/kg/day, which was increased to 1.5 mg/kg/day. Except for an initial mildly beneficial response, the skin lesions were largely resistant to high doses of isotretinoin at the end of four months.

Tratamiento del acné: recomendaciones del Comité de Expertos / Treatment of the acne: recommendations of the Expert Committee

La incidencia de acné vulgar es extremadamente alta en adolescentes y adultos jóvenes; 80% de las personas entre 11 y 30 años presentan la enfermedad. La lesión acneiforme nace en la unión pilosebácea (folículo piloso, pelo y glándula sebacea). El punto de inicio del padecimiento (inflamatorio o no inflamatorio) es el desarrollo del microcomedón. Cuatro factores contribuyen a la presencia del acné: descamación anormal de los queratinocitos dentro la unidad pilosebácea, incremento de la producción de sebo, proliferación de Propionibacterium acnes e inflamación.

Comparative efficacy and safety and efficacy of systemic 13-cis retinoic acid 20 mg/day vs. 40 mg/day in acne vulgaris

Early and effective treatment in acne vulgaris is essential to prevent facial scarring and psychological distress. To evaluate the safety and efficacy of two different doses of 13-cisretinoic acid in the treatment of acne vulgaris. Sixty patients of moderate to severe acne vulgaris were selected from the dermatology out patient clinics of Abbassi Shaheed hospital, Aga Khan Hospital, Burhani Hospital and Taj Medical Complex, Karachi. They were randomly divided into two groups. Group I was given 20mg systemic 13-cis retinoic acid daily and group II, 40mg daily for 24 weeks. Assessment of the severity of acne was done using Global Acne Grading System [GAGS]. Clinical improvement was measured on physician acceptance scale, every two months till 24 weeks. Safety was evaluated on the basis of side effects and lab abnormalities at the baseline and end of therapy. Marked dose related decrease in acne lesions was noted within 8 weeks of the onset of therapy in all patients. In group I, out of 30 patients 24 showed 70% clearance in 8 weeks, 90% clearance in 16 weeks and 100% in 24 weeks, with residual pits in four patients. Six female patients were prescribed Diane 35' at 24 weeks, who still had premenstrual flare of acne. In group II, 26 patients out of 30 showed 90% clearance in 8 weeks and 100% clearance from 16-24 weeks. Mild scarring was noted in six patients at 24 weeks of treatment. Three female patients still had new eruption and were given Diane 35' after 24 weeks and in one male patient the dosage was increased to 60mg/day, which cleared the acne in 32 weeks. The results of two groups were insignificant [p>0.5]. Side effects noted were cheilitis, dryness pruritus and desquamation of skin, more in group II. A mild mood change with irritability was noted in 3 female patients. 13-cis retinoic acid is safe and efficacious in the treatment of acne vulgaris. A dose-dependent faster response is seen, although 20 mg/day works equally well than 40mg/day till 24 weeks

Facial resurfacing of atrophic acne scars using high-energy pulsed carbon dioxide laser

Background and treatment of atrophic facial acne scars has been limited to the use of traditional methods such as dermabrasion and chemical peels for many years. Recently, high-energy pulsed carbon dioxide [CO 2] laser has been introduced for cutaneous resurfacing. This study was designed to determine the effectiveness and safety of high energy pulsed CO 2 laser in the treatment of facial atrophic acne scars and the occurrence of side effects. Patients and in this study, twenty-two patients with skin phototypes I. II, and III and moderate to severe atrophic facial acne scars were included. Each patient received one high-energy pulsed CO 2 laser treatment session using identical laser parameters by the same laser surgeon. Base line and postoperative clinical assessments and photographs were obtained in all patients. there was 90.5% average clinical improvement observed in acne scars following laser treatment. Side effects were limited to transient hyperpigmentation [4.5% of patients] lasting an average of 3 months. Prolonged erythema [2 months average] was usual and was considered a normal healing response. There was no hypoigmentation, hypertrophic scarring or skin infection following laser treatment. high-energy pulsed CO 2 laser proved to be a safe and effective method in the treatment of atrophic facial acne scars

Acné y algo más / Acne and something more

Paciente de 16 años, de sexo femenino, que consulta por acné, pero al interrogatorio y examen físico surgen otros datos que nos hacen sospechar el diagnóstico definitivo. Presenta hipertricosis generalizada, xerosis y cicatrices por quemadura de cigarrillo y refiere preocupación por la silueta, pérdida de peso y amenorrea. La evaluación psiquiátrica encuadra a la paciente en el diagnóstico de anorexia nerviosa. Motiva esta comunicación la importancia de destacar los signos dermatológicos de esta condición, ya que puede ser la clave para el diagnóstico de una patología que tiene serias complicaciones médicas y alta morbimortalidad