Acne Vulgaris Case Study

1. Rzany B, Kahl C. Epidemiology of acne vulgaris. J Dtsch Dermatol Ges. 2006;4:8–9.[PubMed]

2. Kulthanan K, Jiamton S, Kittisarapong R. Dermatology life quality index in Thai patients with acne. Siriraj Med J. 2007;59:3–7.

3. Misery L. Consequences of psychological distress in adolescents with acne. J Invest Dermatol. 2011;131:290–2.[PubMed]

4. Tan JK. Psychosocial impact of acne vulgaris: Evaluating the evidence. Skin Therapy Lett. 2004;9:1–3, 9.[PubMed]

5. Magin P, Adams J, Heading G, Pond D, Smith W. Psychological sequelae of acne vulgaris: Results of a qualitative study. Can Fam Physician. 2006;52:978–9.[PMC free article][PubMed]

6. Purvis D, Robinson E, Merry S, Watson P. Acne, anxiety, depression and suicide in teenagers: A cross-sectional survey of New Zealand secondary school students. J Paediatr Child Health. 2006;42:793–6.[PubMed]

7. Loney T, Standage M, Lewis S. Not just ‘ skin deep’: Psychosocial effects of dermatological-related social anxiety in a sample of acne patients. J Health Psychol. 2008;13:47–54.[PubMed]

8. Yazici K, Baz K, Yazici AE, Köktürk A, Tot S, Demirseren D, et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol. 2004;18:435–9.[PubMed]

9. Sayar K, Ugurad I, Kural Y, Acar B. The psychometric assessment of acne vulgaris patients. Dermatol Psychosom. 2001;1:62–5.

10. Khan MZ, Naeem A, Mufti KA. Prevalence of mental health problems in acne patients. J Ayub Med Coll Abbottabad. 2001;13:7–8.[PubMed]

11. Picardi A, Mazzotti E, Pasquini P. Prevalence and correlates of suicidal ideation among patients with skin disease. J Am Acad Dermatol. 2006;54:420–6.[PubMed]

12. Fakour Y, Noormohammadpour P, Ameri H, Ehsani AH, Mokhtari L, Khosrovanmehr N, et al. The effect of isotretinoin (roaccutane) therapy on depression and quality of life of patients with severe acne. Iran J Psychiatry. 2014;9:237–40.[PMC free article][PubMed]

13. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) – A simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210–6.[PubMed]

14. Adityan B, Kumari R, Thappa DM. Scoring systems in acne vulgaris. Indian J Dermatol Venereol Leprol. 2009;75:323–6.[PubMed]

15. Tasoula E, Gregoriou S, Chalikias J, Lazarou D, Danopoulou I, Katsambas A, et al. The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey. An Bras Dermatol. 2012;87:862–9.[PMC free article][PubMed]

16. Reich A, Trybucka K, Tracinska A, Samotij D, Jasiuk B, Srama M, et al. Acne itch: Do acne patients suffer from itching? Acta Derm Venereol. 2008;88:38–42.[PubMed]

17. Wu SF, Kinder BN, Trunnell TN, Fulton JE. Role of anxiety and anger in acne patients: A relationship with the severity of the disorder. J Am Acad Dermatol. 1988;18(2 Pt 1):325–33.[PubMed]

18. Ogedegbe EE, Henshaw EB. Severity and impact of acne vulgaris on the quality of life of adolescents in Nigeria. Clin Cosmet Investig Dermatol. 2014;7:329–34.[PMC free article][PubMed]

19. van der Meeren HL, van der Schaar WW, van den Hurk CM. The psychological impact of severe acne. Cutis. 1985;36:84–6.[PubMed]

20. Feingold A. Good-looking people are not what we think. Psychol Bull. 1992;111:304–41.

21. Motley RJ, Finlay AY. How much disability is caused by acne? Clin Exp Dermatol. 1989;14:194–8.[PubMed]

22. Yolaç Yarpuz A, Demirci Saadet E, Erdi Sanli H, Devrimci Ozgüven H. Social anxiety level in acne vulgaris patients and its relationship to clinical variables. Turk Psikiyatri Derg. 2008;19:29–37.[PubMed]

23. Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther. 2006;19:237–40.[PubMed]

24. Walker N, Lewis-Jones MS. Quality of life and acne in Scottish adolescent schoolchildren: Use of the Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI) J Eur Acad Dermatol Venereol. 2006;20:45–50.[PubMed]

25. Layton AM. Rook's Textbook of Dermatology. Wiley-Blackwell Publication: Oxford; 2010. pp. 1–89.

26. Pruthi GK, Babu N. Physical and psychosocial impact of acne in adult females. Indian J Dermatol. 2012;57:26–9.[PMC free article][PubMed]

27. Rubinow DR, Peck GL, Squillace KM, Gantt GG. Reduced anxiety and depression in cystic acne patients after successful treatment with oral isotretinoin. J Am Acad Dermatol. 1987;17:25–32.[PubMed]

28. Tedeschi A, Dall’Oglio F, Micali G, Schwartz RA, Janniger CK. Corrective camouflage in paediatric dermatology. Cutis. 2007;79:110–2.[PubMed]

Acne Vulgaris (Teenage)

A 17 year old male presented with one of the worst cases of cystic acne i had seen. The boy & his mother had frequented their local doctor surgery several times over the years with differing results ; at first repeated roaccutane courses seemed positive, as did recurrent antibiotic therapy, although over time his symptoms were continual and the pharmaceutical side effects were proving a problem. It had now been 4 years…

The Acne Vulgaris patient was a fairly sensitive type, and the self esteem / social implications the acne was causing were huge. The symptoms had been progressive for 4 years, worse on the jawline, upper forehead, cheeks and temples. Skin specialists were at a loss in knowing what to do next. The lesions produced a lot of pus and would bleed particularly easily, and his skin was very itchy. The patients mother noticed a foul ‘sulphur’ smell which would infect his clothing & bedding and was getting worse. His diet was fairly typical for a boy his age, and was full of refined / convenient foods. He knew this would need to change!

Treatment:

The diet required a real shift, which i really hate doing in teenage cases as compliance is often a concern. Fortunately the patient was really keen to do whatever was necessary. I took him off dairy, sugar, peanuts, smoked meats, vegetable oils (inc margarine), alcohol, carbonated drinks, and white flour products. I increased his daily protein intake to 1.5g/kg to increase the skin healing process and to stabilise his blood sugar levels. I also increased his water intake to 2.5l / day.

His medication base consisted of the Chinese herbal formulas, siler combination & coix, plus a herbal alterative (bowel / liver), a broad spectrum probiotic (after all the antibiotic use) and a hormonal homoeopathic phenolic agent to de-sensitise his body to the mass of age-appropriate hormones running through his body! I also took him off roaccutane, and provided a broad spectrum healing agent & antimicrobial herbal cream to use topically on affected areas.

Results:

Within 4 weeks his mother noted that the foul sulphur smell had completely stopped, and his skin had ceased to itch. The dark, purple / mottled skin presentation was really improved and the skin tone generally had lightened. The skin was still very cystic, with small new breakouts.

5 weeks later on the same treatment, no cysts were evident along the jaw line. The patient also started using a surgical silica patch on the non-affected skin to promote healing (not supplied by me). At this point i ceased the Chinese herbs, maintained the phenolic agent, probiotic and alterative. I added a high potency vit c / zinc powder and a high quality liquid fish oil @ 1 tsp per day to drive down inflammation & further promote healing.

6 weeks later the patient had absolutely no cystic acne or breakouts of any kind. I actually recommended the patient seek advice from a cosmetic surgeon at this point, to address skin ‘pitting’. I maintained treatment with the liquid fish oil and probiotic.

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