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2. OTHER ACNEIFORM ERUPTIONS
2.1 Rosacea
Rosacea is a disease of unknown aetiology. It is seen in both sexes and is rare before the fourth decade. Patients usually complain of flushing attacks and erythema the face. Examination will reveal acneiform papule, pustules, telangiectasia and dilated venules on the face especially over the nose and cheeks. Its late onset and absence of comedones differentiate it from acne vulgaris. Rhinophyma is a known complication where there is a marked hyperplasia of the sebaceous glands of the nose. Other complications include conjunctivitis, blepharitis and keratitis. Treatment with low dose tetracycline is usually effective. Other antibiotics effective in acne vulgaris can also be used. Metronidazole either as a topical or a systemic therapy is also helpful. Topical steroids, especially potent ones, should be avoided because rebound vasodilatation may actually worsen the condition.
2.2 Perioral Dermatitis
Perioral dermatitis results from prolonged therapy with potent topical corticosteroid therapy. It affects predominantly young women and the clinical appearance is characteristic. There are red papules and pustules, often on a background of erythema and scaling, around the mouth. Discontinuing the topical steroids is the most important step in treating this condition. Oral tetracycline 250 mg two to three times daily for one month is usually successful.
2.3 Steroid Acne
Although a number of drugs can cause an acneiform eruption, by far the commonest cause of drug induced acne is systemic corticosteroid therapy. Steroidal acne usually appears as a monomorphic erythematous papular eruption on the face, upper chest and back of the patients on systemic steroid therapy. Withdrawal of therapy will usually lead to a remission.
2.4 Pityrosporum Folliculitis
Histologically, there is inflammation of the hair follicle with presence of spores of the pityrosporum yeast. Clinically there is a fairly monomorphic papular to pustular eruption on the upper back and chest. The face is not usually involved but association with acne vulgaris is common. Treatment with conventional antiacne therapy is usually futile. Systemic antifungal therapy with ketoconazole or itraconazole has to be used. Topical antifungals, like clotrimazole cream, have been reported to be useful.
2.5 Oil Acne and Chloracne
Industrial workers may develop acne when exposed to industrial oil and other chlorinated hydrocarbon. Oil acne is typically seen on the thighs and knees and appears as an acneiform eruption.
2.6 Gram-negative Folliculitis
Patients on long term antibiotics for inflammatory acne will occasionally complicate by crops of pustules or deep seated nodules around nose. Culture of these lesions reveals Enterobacter, Klebsiella or Proteus. Treatment with Roaccutane is very effective. Ampicillin is also effective to suppress the disease.
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