Skin and soft tissue infections

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Acne

Case report:

An 18 year old female patient complains of increasing typical acne formation on the face, especially on both cheeks, but also with extension to the rear parts of the neck and partly also on the skin of the upper chest. Despite local treatment, the pustules had increased and partly there had been confluent abscesses. In her work as a saleswoman she was greatly affected by this very unpleasant skin changes and they now expect effective medical assistance.

Pathogenesis:

Acne is a chronic inflammation of the sebaceous glands of the skin. This inflammation is caused by the Corynebacterium acnes and entertain, which is able to produce free fatty acids. The inflamed glands can form isolated yellowish to reddish pustules that are visible on the skin but also with several confluent glands. In most cases, these lesions are the face, Halsbreich, the thoracic region and also in the back area detectable. Hormonal influences are discussed, as this disease occurs predominantly in adolescents.

Therapy:

Mostly in milder forms is a topical treatment with vitamin A acid derivatives [e.g. Tretinoin (Airol et al)] or benzoyl peroxide (PANOXYL et al) is initiated with an additional application of UV light, and expressions of the comedones. Frequently, local applications of combination products with clindamycin (BASOCIN), tetracycline (IMEX, among others) or erythromycin (Aknemycin among others) are made.
For lack of success of the local treatment or severe forms, such as e.g. acne conglobata, an oral treatment with a tetracyclin, e.g. with the most lipophilic minocycline (Klinomycin) made daily in a daily dose of 50 mg or doxycycline (VIBRAMYCIN among others) at a dose of 100 mg. Since this often is a longer term therapy, this must be monitored regularly and intensively in the rather low dosage of the substances used because of possible side effects. Systemic antibiotic therapy for acne is only in severe cases!

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