Adult acne

Acne is a common, chronic inflammatory disorder of the pilosebaceous unit in which a microcomedo develops as the initial condition. The most common form of acne is acne vulgaris. Other variants of acne are neonatal acne, adult acne, acne cosmetica, and acne mechanica. These descriptors refer to age of onset or causative factors. 

Acne age of onset varies, but usually begins at puberty. A form of acne called adult acne may first occur after the mid-20s, affecting females more than males, and with lesions generally distributed in the lower facial area around the mouth, chin, and jaw line. ... 

Adult acne can be a continuation of teenage acne or appear de novo. It may differ clinically showing fewer comedones and more inflammation, affecting most commonly the perioral, chin, and jawline regions. A typical clinical characteristic of acne in adult women refers to topography of lesions predominance of lesions in the upper half of the face, in addition to dorsum of younger patients. In the meantime, adults presented more lesions in the neck, in addition to face (Fig. 13.8). 

Mandehc acid has a long history of use in the medical community as an antibacterial, particularly in the treatment of urinary tract infections. It has also been used as an oral antibiotic. Lately, Mandehc acid has gained popularity as a topical skin care treatment for adult acne. It is also used as an alternative to glycohc acid in skin care products. Mandehc acid is a larger molecule... 

Cunliffe3 WJ, Gould DJ (1979) Prevalence of facial acne vulgaris in late adolescence and in adults. BMJ 1 1109-1110... 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

Rosacea chronic presentation of acne in adults characterised by dilation of the blood vessels of the face resulting in a flushed appearance... 

The use of Thera Wise bioactive natural therapeutic ointment, so-called Miracle oil obtained from Tamanu oil in the South Pacific has been reported.This ointment has been used as a skin healing remedy in the treatment of skin burns, eczema and can be used both for infants and adults. The wide range of the Thera Wise agents include the SHO Natural Skin Healing Ointment which has been reported to be an excellent alternative to corticosteroids, anti-itches and antibacterials, while the HmR Natural Hemorrhoidal Ointment has been reportedly used in the treatment of hemorrhoids and hemorrhoids associated with pregnancy. The Ac-f Natural Acne Ointment has been employed as a gentle, balanced supportive care for the treatment of acne. 

All of these metabolites possess retinoid activity that is in some in vitro models more than that of the parent isotretinoin. However, the clinical significance of these models is unknown. After multiple oral dose administration of isotretinoin to adult cystic acne patients (18 years of age and older), the exposure of patients to 4-oxo-isotretinoin at steady state under fasted and fed conditions was approximately 3.4 times higher than that of isotretinoin. In vitro studies indicated that the primary P450 isoforms involved in isotretinoin metabolism are 2C8, 2C9, 3A4, and 2B6. Isotretinoin and its metabolites are further metabolized into conjugates, which are then excreted in urine and feces. 

Excretion - Following oral administration of an 80 mg dose of C-isotretinoin as a liquid suspension, C-activity in blood declined with a half-life of 90 hours. The metabolites of isotretinoin and any conjugates are ultimately excreted in the feces and urine in relatively equal amounts (total of 65% to 83%). After a single 80 mg oral dose of isotretinoin to 74 healthy adult subjects underfed conditions, the mean elimination half-lives of isotretinoin and 4-oxo-isotretinoin were approximately 21 and 24 hours, respectively. After single and multiple doses, the observed accumulation ratios of isotretinoin ranged from 0.9 to 5.43 in patients with cystic acne. 

Interferes w/ DNA synth Dose Adults. Anaerobic Infxns 500 mg IV q6-8h Amebic dysentery 750 mg/d PO for 5-10 d Trichomoniasis 250 mg PO tid for 7 d or 2 g PO X 1 C. difficile 500 mg PO or IV qSh for 7-10 d (PO preferred IV only if pt NPO) Vaginosis 1 applicator-full intravag bid or 500 mg PO bid for 7 d Acne rosacea/skin Apply bid Peds. 30 mg/ kg PO/IV/d q6H, 4 g/d max-s-. Amebic dysentery 35-50 mg/kg/24 h PO in 3 -s- doses for 5-10 d Rx 7-10 d for C. difficile-, in hepatic impair Caution [B, M] Avoid EtOH Contra 1st tri of PRO Disp Tabs, caps, IV, topical lotion, intravag gel, cream SE Disulfiram-like Rxn dizziness, HA, GI upset, anorexia, urine discoloration Interactions t Effects W/ cimetidine T effects OF carbamazepine, fluorouracil, Li, warfarin -1- effects W/ barbiturates, cholestyramine, colestipol, phenytoin EMS t Effects of anticoagulants concurrent EtOH use can cause disulfiram-like Rxn (tach, N/V, sweating, flushing, headache, blurred vision, confusion) may cause a metallic taste and discolored urine OD May cause N/V/D, numbness in hands and feet, Szs, and loss of coordination symptomatic and supportive... 

Minocycline (Solodyn) [Antibiotic/Tetracycline] Uses Acne Action Tetracycline, bactmostatic Dose Adults Peds >12 y. 1 mg/kg PO daily X 12wk w/ food to -1- irritation Caution [C, ] assoc w/ pseudomembranous colitis w/ renal impair Contra AU gy, women of childbearing potential Disp Tabs SE D, HA, fevCT, rash, joint pain, fatigue, dizziness Interactions t Effects OF digoxin, oral anticoagulants t risk of n hrotox W/ methoxyflurane X effects W/... 

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