ACNE RELATED CONDITIONS It is a disorder affecting the pilosebaceous units of the skin

A) Non-Inflammatory acne lesions (comedones) 1) Open comedones (black heads) 2) Closed comedones (white heads) Clinical presentation: found in areas with numerous sebaceous glands. B) Inflammatory acne lesions 1) papules 2) pustules 3) nodules or cysts CLINICAL FINDINGS • Scar, nodules & cyst Type of acne: • Conglobata • Fulminans • Neonatal • Steroid acne • Acne-form eruption Pathogenesis: • Androgens • Follicular obstruction • Propionobacterium acne Therapy:  topical agents  systemic antibiotics  systemic retinoid Topical agents: Topical comedolytic agents are: • • • • Tretinoin (Retin A) available in cream, gel and solution formulations. Benzoyl peroxide available in 2.5%, 5% and 10% concentrations Both can cause skin irritation (worse at first 1 to 2 weeks) Topical antibiotics: Clendamycin and erythromycin.

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Systemic antibiotics: • Tetracycline (500 mg twice/day) is the antibiotic of first choice because of its low cost, efficacy and relative safety. Must be taken on an empty stomach. • Erythromycin (500 mg twice daily) the next most often used systemic antibiotics. Systemic retinoids: • Isotretinoin (Accutane) • Vitamin A analogue - Decreases follicular keratinization, sebum production and intrafollicular bacteria count. Side effects: • Almost all patients experience chapped lips and dry skin • Increase liver enzymes • Increase lipids • Teratogenic * Special consent forms, strict birth control measures and monthly pregnancy test are required for female in the productive period. ROSACEA Chronic inflammatory disorder affecting the blood vessels and pilocebaceous units of the face. CLINICAL FINDINGS • Papules and pustules are super imposed. • On a background of erythema and telangiectasia • On the central third of the face Differential Diagnosis: - Lupus erythematosus - Photodermatitis - Carcinoid syndrome Complications: - Rhinophyma - Ocular complications - Blepharitis - Conjuctivitis - Keratosis (may lead to blindness) Treatment: - Low dose tetracycline or erythromycin (250 mg twice daily) - Topical metronidazole 0.75% gel (metro gel) is effective in treating papules, pustules and erythema of rosacea. - Isotretinoin (Accutane) – for resistant cases. - Avoid stronger cortisone preparations and sun exposure.

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PERIORAL DERMATITIS - Papules and pustules - Cosmetic related - Sparing zone - No comedones nor telangiectasia - Rx – avoid the offending cause

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