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Variants Of Acne
Acne vulgaris is a disease of the pilosebaceous unit, manifesting as comedones, pimples, pus filled boils, nodules, and cysts. Most of us have suffered from pimples in our teens and tween years. Some individuals develop acne, even past middle age. The common variants of acne, include the following :
1. Acne excorie'e
This variant occurs predominantly in women, who pick their own skin, to exacerbate even the smallest boils. There is often some personality or psychological problem associated with this condition.
2. Acneform Eruptions Caused By Medicines
Corticosteroid tablets, ointments, or intranasal sprays, ACTH (Adreno Cortico Tropic Hormone) injections, may provoke an acneiform reaction. Steroid intake for prolonged periods results in crops of boils, that are exactly same in size, shape, and color, and are known as monomorphic acne. Androgens, including anabolic steroids and gonadotropins, may precipitate acne, especially in women, and in atheletes who take illegal performance enhancing drugs. There is a legal and official ban imposed on intake of these drugs, which, along with other side effects, cause an increase in sebum (the oily sticky material released from oil glands of the face, chest, and back) and the skin surface population of Propionibacterium acnes, the culprit microbe responsible for causing acne. Contraceptive pills may also result in deterioration of pre-existing acne. Medicines such as phenytoin, used in the treatment of seizures or convulsion disorder, have also been incriminated as causative agents. Antitubercular medicines, especially isoniazid, make a person more prone to acne. PUVA (Psoralens and Ultra Violet-A) therapy used to treat skin conditions, iodides, bromides, and lithium, can also lead to frequent breakouts. The causative medicine should be discontinued, if possible, before the anti-acne therapy is begun.
3. "Endocrine" Acne
Acne may develop in disorders associated with hormonal imbalance, such as Cushing's syndrome (an excess of hormone cortisol) and Poly Cystic Ovarian Syndrome, which is the commonest cause of "endocrine" acne.
Gram negative folliculitis
4. Severe Acne Variants
These include the following :
- Pyoderma faciale or Rosacea fulminans : This is an uncommon condition related to rosacea (a vascular disorder, predominantly affecting the flush area of face, manifesting with redness and appearance of fine red streaks, that are actually minute capillaries filled with blood, on skin surface, punctuated with episodes of inflammation, during which, red bumps, pus filled boils and swelling of face, develop) that occurs in individuals who usually have mild disease, which suddenly erupts, producing many pus filled pimples and nodules, especially on the face. It mainly affects post-adolescent women in second to the fouth decade of life, often following a period of stress. Comedones are rare, and flushing of face frequently precedes the acute illness. This condition occurs in association with Crohn's disease, in some individuals.
- Acne conglobata : This is a very uncommon, but severe form of acne, found particularly in men. Nodules that fuse to form multiple draining sinuses, occur on the trunk, face, and limbs. Grouped, multiple, fused blackheads and extensive scarring also occur. This disease persists into 40-50 years of age.
- Acne fulminans : This is an uncommon condition, that predominantly affects young men. It presents as a sudden eruption of red colored, swollen inflammatory acne, especially on the trunk, in association with fever, pain, and swelling of multiple joints, and weight loss. It is also accompanied by a sense of feeling unwell, and loss of appetite. Enlargement of spleen, bone pains, and painful red nodules on the front of legs, thighs, and forearms, known as erythema nodosum, may occur on the legs. It is an immunologically induced illness, caused due to hypersensitivity to the bacterium Propionibacterium acnes, the causative agent of acne.
- Gram Negative Folliculitis : This is a complication of longterm treatment of acne with antibiotics. It presents, either as a sudden eruption of multiple, small pus filled pimples or as nodules. Continuous longterm use of antibiotics results in a decrease in skin immunity, that causes growth of unrelated bacteria, on which the given antibiotics do not have any effect.