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Acne SOS

By DR. GRACE CAROLE BELTRAN, The Philippine STAR Published Jan 18, 2022 5:00 am

We have all experienced acne at least once in our lifetimes. Unfortunately, these annoying bumps tend to pop out at the worst times: on the morning of a big date, on the day of an important meeting, or an engagement such as one’s wedding day.

Look in the mirror one day, and what do you see? A breakout! That is how unpredictable acne is. Why? Because it has multifactorial triggers which you really cannot monitor and control entirely.

Acne is a common problem that affects people of all ages — boys, girls, men and women. Many young adults deal with acne. But if you think it’s only a teenage problem, you’re mistaken. Acne also affects adults and even infants, too.

Acne is a common problem that affects people of all ages.

Now, there is a growing list of severe acne conditions that are resistant to the usual treatments that we usually prescribe for acne patients.

These include:

  1. Acne with a duration of over five years
  2. Acne among patients who irrationally use antibiotic therapy
  3. SAHA, a medical syndrome characterized by seborrhea, acne, hirsutism and alopecia, among smoking women with hormonal and endocrine disorders like polycystic ovary syndrome (PCOS), a condition in which the ovaries produce an abnormal number of androgens (male sex hormones) that are usually present in women in small amounts.

SAHA is frequently associated with PCOS, cystic mastitis, obesity and infertility; androgen excess, the most common endocrine disorder in women of reproductive age. Androgens are produced primarily from the adrenal glands and the ovaries. However, peripheral tissues such as fat and skin also play roles in converting weak androgens to more potent ones.

Androgen excess can affect different tissues and organs, causing variable clinical features such as acne, hirsutism, virilization and reproductive dysfunction. 

Patients with the above-mentioned conditions, when they exist together, are 2.61 to 6.13 times more likely to manifest resistant forms of acne.

Antibiotic-resistant acne is suspected in cases when there is no improvement in the context of good compliance; early response is followed by a relapse in the face of continued treatment; a patient has had multiple courses of oral/topical antibiotics without much improvement; and a patient has a poor compliance with therapy.

Oral antibiotics should be used for the shortest time possible to prevent resistance.

4. Nodulocystic acne (large, painful nodules and pustules and acne with macrocomedones, sinus tracts and excess granulation tissue).

5. Adult acne, or acne that occurs after age 25 (82 percent fail multiple courses of systemic antibiotics; 32 percent relapse after tretinoin; recurrence shortly after treatment with isotretinoin should trigger suspicion of underlying hormonal disorder). 

6. Acne from isotretinoin relapse and failure. Fourteen to 52 percent of patients in varying studies tend to relapse after isotretinoin treatment. It mainly occurs in the first two years after discontinuation of this treatment.

7. Severe acne in the family. Increased resistance (10 to 50 percent) is seen in family members with strong family history.

Suspicion of an underlying endocrinology disorder should be heightened if a recurrence of acne appears shortly after treatment with isotretinoin.

There is a growing list of severe acne conditions that are resistant to the usual treatments.

  1. Acne from prolonged usage of cosmetics.
  2. Acne from prolonged contact with chemicals (occupational acne), occlusive clothing and physical exercise.
  3. It could be gram-negative folliculitis and not acne. Gram-negative folliculitis (due to microorganisms like klebsiella, e.coli, proteus, serratia or pseudomonas) may be the cause of apparent failure to respond.
  4. Biofilm formation. A complex aggregation of microorganisms (cutibacterium acnes) that encase themselves within an extracellular polysaccharide lining, which the organisms secrete after adherence to a surface (the lining inside the gland). This is 50 to 500 times more resistant to antimicrobial therapies.

If you have acne that is resistant to treatment, consult a board-certified dermatologist immediately to avoid severe scarring and loss of self-esteem and confidence.