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Pustular acne
Papules, pustules, and comedones are intermixed. Pustules are superficial and may break and drain.
Moderate papulopustular acne. The propensity to scar varies among patients.
Widespread pustular acne is disfiguring, has the potential to scar, and requires aggressive therapy (often with isotretinoin).
The course and extent of acne are highly variable and unpredictable. Chest and back involvement is common. This severity of acne is an indication for isotretinoin.
DESCRIPTION
Papulopustules evolve from comedos.
HISTORY
• Common in the teenage years; many adults affected. • Lasts longer in women; more severe in men • Patients often pick acne, creating scars (acne excoriee). Deep lesions may also leave scars.
PHYSICAL FINDINGS
• Comedones, papules, pustules, cysts and scars, involving the face, chest, back and arms. Post-inflammatory pigmentation is common, especially in darkly pigmented individuals.
TREATMENT
• Mild to moderate. Treat with topical antibiotics and retinoids or topical antibiotics and sulfacetamide/sulfur. • Moderate and severe. Treat with topical antibiotics, sulfacetamide/sulfur and oral antibiotics. Consider isotretinoin for failures. • Women. Oral contraceptives (e.g. Ortho Tri-Cycle, Alesse) and Spironolactone 50–200 mg q.d. may be effective. Check testosterone, follicle-stimulating hormone, luteinizing hormone, dehydro-epiandrosterone-S, prolactin in women with persistent acne or irregular periods. • Topical antibiotics. See Comedonal acne • Sulfacetamide/sulfur. Lotion 10–5%, 30, 60 g Many washes and topical preparations • Retinoids: see Comedone acne. • Oral antibiotics. Tetracycline 250 or 500 mg b.i.d.; Doxycycline 20, 50, 75, 100 mg q.d. or b.i.d.; Minocycline 50, 100 mg b.i.d.; Isotretinoin 10, 20, 30, 40 mg. Isotretinoin is used in severe acne at dose of 0.75–1 mg or 2 mg/kg q.d. for a course of 4–5 months. It is highly teratogenic and there are restrictions on use of this drug. iPLEDGE registry is required for patients and prescribing physicians for isotretinoin use in the USA.
