Objectives: ACNE CONGLOBATA TREATED WITH COMBINATION OF LOW-DOSE ISOTRETINOIN, TOPICAL TRETINOIN AND ANTIMICROBIAL
Ratih Vibriyanti Karna
Departement of Dermatology and Venereology Faculty of Medicine Udayana University, Sanglah General Hospital Denpasar, Bali
Abstract
Introduction: Acne conglobata is a rare form of severe nodular acne. It can cause severe scars and psychological impact such as anxiety and depression. Acne conglobata is very difficult to treat.
Introduction: Case : A 31-year old woman referred to hospital with severe acne on her face since 1 year ago, accompanied with pain and itchy. She had mild acne since 3 years ago, but 1 year ago after divorced with her husband, the acne getting worse. Patient complaints lack of confidence because of the acne. History of treatment with oral antibiotics, acne injection and topical treatment only resolved the acne temporarily.
Materials / method: Examination revealed multiple erythematous nodules, some tender and fluctuant with pain on palpation, multiple papules, pustules and atrophic acne scars in variant sizes, also open and closed comedones. No fever and arthralgia, laboratory tests within normal limit. Patient was diagnosed with acne conglobata and treated with isotretinoin 10 mg orally once daily, tretinoin cream 0.025% and clindamycin 2% cream topical once daily. The resolution of the acne completed on the 5th weeks of treatment, the isotretinoin will be continued for 6 months.
Results: Discussion: Acne conglobata is characterized by burrowing and interconnecting abcesses and irregular scars. It usually affects youth and adults. The lesion is polymorphic, with comedones, papules, pustules, nodules, abscesses and scars. Isotretinoin is the first treatment choice for acne conglobata with therapeutic dose 0.5-1 mg/kgBW/day. The combination of low-dose isotretinoin with topical tretinoin and antimicrobial is effective in treating acne conglobata.
Conclusion: This low dose therapy decreases the side effect of isotretinoin, such as cheilitis, xerosis, epistaxis, etc. Tretinoin topical is a potent comedolytic and anti-inflammatory, combination with topical antimicrobial can increase the drug penetration, prevent the comedone formation and decrease the proliferation of P. acnes.
Keywords: acne conglobate, low-dose isotretinoin, topical tretinoin
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