Spontaneous clinical improvement in HIV-associated follicular syndrome

Since 1991 infrequent reports have described a distinctive triad of nodulocystic acne, striking follicular spines and an eruption resembling pityriasis rubra pilaris (PRP) in HIV-positive patients. It has been suggested that this may represent a subtype of PRP, or alternatively that it should be viewed as a unique HIV-associated follicular occlusion triad. Clinical manifestations may be severe, and in several cases have been ultimately fatal, with death occurring due to complications of cutaneous sepsis. We describe a case demonstrating severe conglobate acne, follicular keratotic spines and histologically confirmed PRP in association with HIV infection. Clinical features and treatment modalities of previously reported cases are reviewed. Despite refusing all topical and systemic treatment our patient showed spontaneous remission of skin signs after 2 years.     

HIV-associated pityriasis rubra pilaris responsive to triple antiretroviral therapy

HIV-associated pityriasis rubra pilaris (PRP) or PRP type VI designates a new distinctive entity reported in HIV patients. It is characterized by cutaneous lesions of PRP and variable association with lesions of acne conglobata, hidradenitis suppurativa and lichen spinulosus. We report a patient with HIV-associated PRP which was treated by triple antiretroviral therapy (zidovudine, lamivudin and saquinavir) with complete response. The patient has remained free from symptoms for 20 months of follow-up. We review the clinical features, pathology, evolution, treatment and possible aetiology of this recently described entity.     

Pityriasis rubra pilaris and human immunodeficiency virus infection

Recently, the occurrence of pityriasis rubra pilaris (PRP) has been reported in patients with HIV infection. It presents different clinical features, and has a poorer prognosis, than the classical adult type of PRP. We report the occurrence of severe PRP in an HlV-infected patient, and review the previously reported cases of this association. We propose the designation of a new category of PRP (type 6), characterized by the presence of HIV infection, usually without immunosuppression, a poor prognosis and response to treatment, and the development of nodulocystic and lichen spinulosus lesions.     

Acne is not a stigma of HIV infection: a review of 36 patients

INTRODUCTION: Several diseases with follicular occlusion have been described in HIV-infected patients and can appear isolated or associated with each other in an independent disease named 'HIV-associated follicular syndrome'. Worsening of cutaneous lesions during the course of infection in patients with previous acne vulgaris, late onset or severe forms of acne have been reported in HIV-infected patients. PATIENTS AND METHODS: A prospective study of 335 HIV-infected patients was performed in our hospital. A meticulous dermatological exploration in all patients was made, and multiple data were stored into a Microsoft Access 97 program. Patients diagnosed as having acne were considered separately, and we studied their characteristics. A statistical analysis with SPSS 9.0 (Statistical Package for the Social Sciences) was performed. RESULTS: Thirty-six patients (10.8%) were diagnosed as having acne. Papulopustular lesions were the most frequent clinical presentation. Most lesions were localized on the face or on the back, and 80% of patients had mild to moderate acne; 40% of them required no treatment and the remainder was treated with topical measures, oral antibiotics and isotretinoin. 85% of cases reported the onset of acne during adolescence or before HIV infection and without any relationship with this disease. No relation between acne intensity and stage of HIV infection was observed. A multivariate analysis showed that the most important variable was age. DISCUSSION: In contrast to previous reports, no greater intensity or modifications in acne lesions were observed in our HIV-infected patients during the course of the disease. In the majority of cases, cutaneous lesions started before HIV infection, during adolescence, and the most important factor for suffering from acne was young age. In contrast to data reported in the literature, no relation of acne lesions to CD4 lymphocyte count or AIDS case criteria was found in our patients. CONCLUSIONS: Acne in HIV-infected patients has characteristics similar to those in non-HIV-infected patients. The age is the most important factor for the appearance of lesions that usually develop during adolescence. Acne lesions are not modified by HIV infection, and no relationship with the severity of HIV infection has been observed.     

Case of coincident severe acne and psoriasis in AIDS patient successfully treated with antiretroviral therapy

Cutaneous disorders remain a major problem in HIV‐infected patients, even under antiretroviral therapy (ART). Patients at any stage of HIV/AIDS may suffer from skin lesions. Acnes and psoriasis are both common chronic and inflammatory skin diseases, and the treatment becomes more challenging and complex when combined with HIV infection. Whether the incidence and severity of acne and psoriasis are related to HIV infection is still controversial. Here, we report a rare case of an AIDS patient who developed severe acne along with psoriasis. The patient had initially received multiple systemic and topical antipsoriatic and anti‐acne treatments which failed. Ultimately, he achieved dramatic clinical improvement after initiation of ART for main treatment. An 8‐year follow up demonstrated that the patient has been free of symptoms of both psoriasis and acne till now.     

Combined subcision,autologous platelet-rich plasma,and CROSS technique in the treatment of atrophic acne scars: Prospective split face study.

Acne scars represent a therapeutic dilemma. This study aimed to evaluate the efficacy of combined subcision, autologous platelet-rich plasma (PRP), and chemical reconstruction of skin scars (CROSS) technique in the treatment of acne scars. In 20 patients with atrophic acne scars, one facial side was treated with subcision plus PRP, and the other was treated with the same combination plus CROSS technique (trichloroacetic acid 50%) for 3 sessions at 3-week intervals. Clinical evaluation, digital photography, quantitative global scarring grading system, and Lipper and Perez score were done at baseline, every session, and 1 month after the last session. Participants assessed their improvement at the end of the follow-up period using a scale (0 to 10). There was a significant reduction in quantitative global scarring grading system (P < .001) and Lipper and Perez score (P < .001) after treatment compared with baseline in both sides. No significant difference was found when the two treated sides were compared after treatment by both scores. Patients’ satisfaction was excellent (12 patients [60%]) and good (eight patients [40%]) with no significant difference between both sides. In conclusion, combined subcision and PRP is recommended for acne scars. Adding CROSS technique (trichloroacetic acid 50%) did not further ameliorate the condition.     

235例痤疮患者并糠秕孢子菌感染特点分析

目的 :探讨糠秕孢子菌对痤疮的影响。方法 :对 2 35例痤疮患者进行糠秕孢子菌检查。结果 :2 35例痤疮患者糠秕孢子菌检出率为 32 34 % ,男女之间比较无显著性差异 (χ2 =0 2 75 ,P >0 0 5 ) ,以学生、干部为多 ,男性 30岁以下感染较多 ,而女性则多集中在 2 0岁～ 30岁之间 ,囊肿型及脓疱型感染率较高。结论 :糠秕孢子菌在痤疮感染中普遍存在 ,对痤疮有重要的病因学意义。     

Evaluation of autologous platelet-rich plasma plus ablative carbon dioxide fractional laser in the treatment of acne scars

Introduction: Acne scar is a common distressing complication of acne vulgaris. CO₂ laser resurfacing proved effective for the treatment of this problem, but the associated complications may limit its use. Platelet-rich plasma (PRP) may increase the chance of favorable outcome. Aim of the work: To evaluate the synergistic effects of autologous PRP with fractional CO₂ laser resurfacing in the treatment of acne scars among Egyptian patients. Patients and method: This study included 30 patients suffering from post-acne scars. CO₂ laser treatment was applied to both sides of the face followed by PRP injection for the right side. Evaluation was carried out through operating physicians, two blinded physicians as well as through patient’s satisfaction. Result: The right side of the face (PRP-treated side) achieved excellent improvement in 13.3% of the patients, while there was no excellent improvement on the left side. Conclusion: Combination of fractional CO₂ laser resurfacing and intradermal PRP was superior to CO₂ laser alone for acne scar treatment.     

Historical Aspects of the Oral Use of Retinoids in Acne

A number of investigations of the effects of vitamin A deficiency in animals and man and its treatment with natural products containing vitamin A were carried out in the twenties and thirties. In 1942, a clinical study in patients with acne treated with vitamin A yielded encouraging results. Further trials in the forties and fifties, trying to confirm the beneficial effect of oral vitamin A in acne, met with equivocal success. In the sixties, all-trans retinoic acid (tretinoin) became clinically available, and its topical efficacy in acne could be demonstrated. In 1971, oral tretinoin also was shown to be active in patients with acne. Coincidentally, the efficacy of oral 13-cis retinoic acid (isotretinoin) became evident in a series of unpublished studies in Europe. Then, in 1978, a trial carried out at the NIH, Bethesda, Maryland, yielded convincing evidence that isotretinoin is a potent new drug for the treatment of severe cystic acne. In 1982, isotretinoin was registered in the United States and one year later in Europe for the treatment of severe, recalcitrant, cystic acne. Since then, many thousands of patients suffering psychologically and physically from the severity of their disease have been treated successfully with this drug. However, the main concern of physicians prescribing isotretinoin has to focus on its potentially severe side effects, particularly its teratogenicity.     

The safety of long-term clindamycin therapy for acne.

Sixty patients with severe pustular and cystic acne were treated for prolonged periods with clindamycin (150 mg to 300 mg daily). The average duration of therapy was five months, with 18 patients being treated for more than six months. Only two (3.4%) patients developed mild diarrhea, which was rapidly reversible on discontinuance of the drug. No other adverse reactions were observed. These data suggest that long-term, low-dose clindamycin therapy may be safe for severe pustular of cystic acne.     

Lipoprotein metabolism and lipoprotein lipase in severe cystic acne

In severe cystic acne we found low levels of high density lipoprotein-cholesterol (HDL-C) and apolipoprotein A (Apo-A) in the presence of normal total lipids. In a larger number of patients, we always observed significantly lower levels of HDL-C and Apo-A than in either age-matched controls or subjects with acne vulgaris. Since lipoprotein lipase is one major determinant of HDL concentration, we assayed the lipase activity in liver and extra-hepatic tissues by the method of Krauss et al. There was highly significant less total and hepatic lipase activity than in age-matched controls. HDL distribution was examined by zonal ultracentrifugation and a decrease in the HDL2 subclass was discovered. Since HDL are inversely correlated to atherosclerosis, cystic acne is one risk factor for atherosclerosis. The linkage between low HDL levels and severe cystic acne should be further investigated.     

Osteonecrosis in acne conglobata

We report on a 17-year-old man suffering from acne conglobata, who developed osteomyelitis with osteonecrosis of the left clavicula after a rash of acne fulminans. The infection spread from a cystic nodule into the adjacent bone.     

Isotretinoin versus minocycline in cystic acne: a study of lipid metabolism

We have recently reported that patients with severe nodular cystic acne have much lower levels of HDL-cholesterol, apolipoprotein A and hepatic lipoprotein lipase than healthy controls or subjects with acne vulgaris. Since isotretinoin is very effective in the treatment of the nodular cystic acne but has been shown to increase blood lipid levels, we decided to compare its clinical effectiveness and its effects on lipid metabolism with those of minocycline in patients with nodular cystic acne. After 20 weeks, the number and mean diameter of the cysts were definitely decreased in both groups, but the improvement was more striking in the isotretinoin-treated group. At the end of the treatment, the HDL-C and hepatic lipoprotein lipase levels in this group were increased toward normal, but not in the minocycline-treated group. Our study showed a significant remission in the acne of patients treated with isotretinoin but not in that of the minocycline-treated patients. Furthermore isotretinoin can also correct the altered lipid metabolism in these patients.     

Combined autologous platelet‐rich plasma with microneedling versus microneedling with non‐cross‐linked hyaluronic acid in the treatment of atrophic acne scars: Split‐face study

Acne scarring causes cosmetic discomfort, depression, low self‐esteem and reduced quality of life. Microneedling is an established treatment for scars. A multimodality approach to scar treatment is usually necessary to achieve the best cosmetic results. The objective of this study was to evaluate the efficacy and safety of platelet rich plasma (PRP) combined with microneedling in comparison with microneedling with non‐cross‐linked hyaluronic acid for the treatment of atrophic acne scars. Forty‐one patients of 20‐40 years of age with atrophic acne scars were included. Microneedling was performed on both halves of the face. Topical application of PRP was given on right half of the face, while the left half of the face was treated with topical application of non‐cross‐linked hyaluronic acid. Four treatment sessions were given at an interval of 1 month consecutively. Goodman's Qualitative scale and the quartile grading scale are used for the final evaluation of results. There was a statistically significant improvement in acne scars after treatment among the studied group. Right and left halves showed 85.4% and 82.9% improvement, So the difference of the improvement between the two modalities is statistically insignificant P > 0.05 We conclude that microneedling has efficacy in the management of atrophic acne scars. It can be combined with either PRP or noncross‐linked hyaluronic acid to enhance the final clinical outcomes in comparison with microneedling alone. The difference between the two modalities is insignificant.     

Microneedling and PRP for acne scars: A new tool in our arsenal

A common complication of acne vulgaris is clinically significant scarring, which can greatly impact patient quality of life. While treatment options have included microneedling, the recent addition of platelet‐rich plasma (PRP) to this regimen has led to an increased popularity of combination treatment. Here, we offer backgrounds on microneedling and PRP therapies and review the literature on combination treatment for acne scars.     

A case of pityriasis rubra pilaris associated with membranous nephropathy

Pityriasis rubra pilaris (PRP) is a rare idiopathic dermatosis which may be associated with autoimmune diseases, HIV infection, and internal malignancies. Its association with renal diseases is, however, much less recognized. We report a case of PRP with associated membranous nephropathy (MN), which resolved spontaneously with resolution of the dermatosis. This is only the second reported association between PRP and MN of which we are aware. Further reports of such an association will strengthen the evidence for the two conditions being linked and may thereby shed light on the pathogenesis of both PRP and MN.     

黄金微针射频联合自体富血小板血浆治疗面部痤疮凹陷性瘢痕的疗效评估

目的 探讨黄金微针射频联合自体富血小板血浆(PRP)治疗面部痤疮凹陷性瘢痕的疗效。方法 选择河南大学第一附属医院皮肤科门诊2019年4月—2021年4月接收且诊治的74例凹陷性痤疮瘢痕患者为对象,随机分为2组。观察组采用黄金微针射频联合PRP治疗,对照组采用滚轮微针联合PRP治疗,两组均治疗间隔4周,连续治疗3次,3次为1疗程。1个疗程结束后6个月随访,比较两组ECCA权重评分和临床疗效分析、记录治疗引起的皮肤损伤相关时间指标。结果 观察组治疗前ECCA权重评分为53.38±19.15,对照组为52.43±25.94,两组差异无统计学意义(Z=-0.64,P=0.524);治疗后观察组ECCA权重评分降低为24.46±14.38,对照组降低为36.08±20.38,观察组低于对照组(Z=-2.20,P<0.05)。观察组和对照组总体有效率分别为91.89%和72.97%,两组差异有统计学意义(χ²=4.57,P<0.05)。观察组患者的红肿持续时间、愈合时间和停工时间均短于对照组患者,差异均有统计学意义(均P<0.05)。结论 黄金微针射频联合P...     

Evaluation of numbers and cost of severe acne in France

The number of patients with acne in France is unknown. During a Winter period (October, 1985 to January, 1986), 31 dermatologists in private practice in 5 different regions (Paris, Lyon, Marseille, Rennes and Strasbourg) saw 4,597 cases of acne among 28,714 patients (16.0 p. 100); 293 (6.4 p. 100) of these acne patients had severe acne as defined in the official authorization to launch the drug isotretinoin on the French market: "Nodular and/or cystic acne and severe chronic acne resistant to the main conventional treatments". The patients' mean age was 24.0 +/- 6.7 years, and 66 p. 100 were male (39 p. 100 were students or grammar school pupils); they had the disease for a mean period of 8.2 +/- 5.9 years, and they consulted a dermatologist 4.15 times per annum on average. By extrapolating these figures to the total number of dermatologists practising in France, it could be assumed that in any given year about 17,738 to 19,333 patients with severe acne consulted dermatologists in private practice. Each dermatologist selected at random the record-cards of 4 of his severe acne patients (in all, 121 records) and gave those who came to consult him a letter explaining the purpose of the study and asking them to accept being questioned on the cost and repercussions of their disease. Sixty patients were interrogated by a psychosociologist, 27 accepted to be interrogated every 2 weeks for 2.5 months. The data collected were: i) number of times the patient consulted a general practitioner, a specialist, a surgeon, or a member of the paramedical professions.(ABSTRACT TRUNCATED AT 250 WORDS)     

他扎罗汀凝胶治疗囊肿性痤疮26例疗效观察

目的：观察他扎罗汀凝胶治疗囊肿性痤疮的疗效。方法：采用随机开放、平行对照法，以他扎罗汀凝胶外用作为治疗组，3％过氧化苯甲酰霜作为对照组，进行对比疗效观察。结果：治疗组治愈率和总有效率优于对照组（P＜0．05）。观察期间未见严重不良反应。结论：他扎罗汀凝胶治疗囊肿性痤疮安全、有效。