Presented
by:
Marina Delgado, M.D.
Apache Junction, Arizona
Marina Delgado, M.D.
Apache Junction, Arizona
The
patient, a 21 woman with a 9 year history of acne is studying in Arizona. Her acne, present since age 12, was relatively
quiescent until it flared three months ago when she was doing research in Southern
China. In the past, she had been treated with topicals, antibiotics and
oral contraceptives. None were effective; but her acne was not florid as it is now.
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| 10.9.2016 |
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| 5.12.2017 |
One of our pediatric dermatology colleagues suggested that this woman has pyoderma faciale.
We recommended isotretinoin plus prednisone but, because
of iPledge, the patient has to wait a month to qualify for isotretinoin.
Have you managed similar patients? What suggestions do you have? What do you see as the role for prednisone and how long shoould it be continued?
References:
1. Pyoderma faciale:
Successful treatment with isotretinoin
Victor J. Marks,
Robert A. Briggaman
J Am Acad Dermatol
17, 1062–106. 1987 PDF.
2. Henry Foong. Pyoderma faciale, Virtual Grant Rounds in Dermatology, October 2001.
3.
2. Henry Foong. Pyoderma faciale, Virtual Grant Rounds in Dermatology, October 2001.
3.
Combination of low-dose isotretinoin and pulsed oral
azithromycin in the management of moderate to severe acne: a preliminary
open-label, prospective, non-comparative, single-centre study. De D1, Kanwar AJ. Clin Drug Investig.
2011;31(8):599-604.
RESULTS: Sixty-two (93.9%) of 66 eligible patients had
complete clearance of disease activity after a mean treatment duration of 21
weeks. The mean total cumulative dose of isotretinoin was 49.6 mg/kg. Seven
(11.3%) patients had a relapse of disease during the post-treatment follow-up
period. Fifty-three adverse effects were observed. Three patients had initial
aggravation of disease that was managed with prednisolone and disappeared with
continuation of treatment.
CONCLUSION: A combination of low-dose isotretinoin and oral
azithromycin pulse is effective in severe acne and has a reasonably acceptable
adverse-effect profile and low post-treatment relapse rates. Abstract.
long hx of acne and presence of what look like comedones on paranasal and chin suggest acne vulgaris as the diagnosis. Agree with systemic retinoids when she can get them. But this is also a neutrophilic process and I'd suggest low dose cyclosporin (50-100mg/day). The risks of renal or hypertensive complications at that dose are close to zero and you will use it for only a few months at most. Fewer side effects than with prednisone.
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