Acne strikes various people in various forms

November 1, 2005

There is a significant variation in the age of sufferers, just as there are various forms of acne.

In a seminar on acne, Gerd Plewig, M.D., discussed the various forms of acne and appropriate treatments for them.

Dr. Plewig, a professor in the department of dermatology at Ludwig-Maximilian University in Munich, Germany, discussed the following acnes forms and acne-like diseases: acne infantum, congenital adrenal hyperplasia, acne inversa, chloracne, Demodex folliculitis and rosacea fulminans.

Within the acne infantum category, Dr. Plewig focused on acne conglobata infantum. He says this form occurs in pre-pubescent patients and that it is typically confined to the face in both males and females.

"Acne conglobata infantum is characterized by papules, pustules, nodules, draining sinuses and depressed scars," he tells Dermatology Times. "This form can persist into puberty."

He suggests treatment beginning with 1 mg/kg of oral corticosteroids, followed by oral erythromycin. In some cases, oral administration of isotretinoin may be deemed appropriate.

Congenital adrenal hyperplasia

Dr. Plewig characterizes congenital adrenal hyperplasia as a group of autosomal recessive disorders of adrenal cortisol biosynthesis, and says that in 95 percent of cases, there is a deficiency of the enzyme hydroxylase.

"Dermatologists should suspect the presence of congenital adrenal hyperplasia in patients with either an early onset of acne, severe or persistent disease, failure of isotretinoin treatment, or hirsutism or irregular menses in women," he says.

Acne inversa

As for acne inversa, Dr. Plewig notes that it most frequently occurs in the area of the armpits, the groin area, and the buttocks. Acne inversa rarely manifests itself in the head or neck area.

Dr. Plewig notes that in all of the above forms, appropriate administration of isotretinoin, often in combination with systemic corticosteroids and surgical interventions, tends to be effective.

"Very low doses of isotretinoin make prolonged treatment possible," he says. "Patients like it, and it is very reasonable in terms of pharmaco-economics. In addition, very low doses control seborrhea, make sebaceous glands smaller, remove persistent follicular lesions and have minimal subjective side effects."

Chloracne

Dr. Plewig describes chloracne as "awful - and still with us." He defines the routes of contamination as being directly through the skin, directly through mucous membranes, through the alimentary tract and through inhalation.

"Chloracne typically results in people who are victims of catastrophic episodes such as accidents in chemical factories, fires and chemical warfare, and can occur as the result of eating contaminated foods," he says.

Diagnosis of chloracne involves a complete clinical picture, thorough histopathology, and blood analysis carried out by certified laboratories, Dr. Plewig says, adding that treatment frequently involves the administration of perioral Olestra, a non-digestible lipophilic fat. He also suggests oral isotretinoin where applicable.

Demodex folliculitus

Dr. Plewig says in Demodex folliculitis, a condition cause by Demodex mites, doctors are likely to observe the following clinical findings: