Fast Five Quiz: Common Skin Conditions

William James, MD

Disclosures

May 20, 2019

Patients with polycystic ovarian syndrome often first present to dermatologists for acne. With its long-term complications of obesity, infertility, and malignancy, this condition needs to be considered when female patients present with acne, particularly with moderate to severe acne in adulthood that is refractory to conventional therapies. These patients should be evaluated for levels of total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, luteinizing hormone, and follicle-stimulating hormone, as well as for lipid panel, glucose value, and insulin level.

During adolescence, acne vulgaris is more common in males than in females. In adulthood, acne vulgaris is more common in women.

Local symptoms of acne vulgaris may include pain or tenderness. Systemic symptoms are most often absent in acne vulgaris. In certain rare, severe cases, acne vulgaris can lead to acne conglobata, with highly inflammatory nodulocystic acne and interconnected abscesses. Acne fulminans is even more severe than acne conglobata, with systemic symptoms such as fever, joint pain, and general malaise.

Antibiotic resistance in Cutibacterium acnes (formerly Propionibacterium acnes) is common and is a significant threat to acne treatment. Antimicrobials should be combined with a topical retinoid for greater clearing of lesions and to increase the potential for shortened antibiotic treatment. They should be used with benzoyl peroxide to reduce the likelihood of resistance. Concurrent use of oral and topical antibiotics should be avoided. Topical antibiotics should not be used as monotherapy. If acne relapses, use the same antibiotic if it was effective previously. It may also be helpful to use benzoyl peroxide for 5-7 days between antibiotic courses to reduce resistance in organisms on the skin.

Read more about acne vulgaris.

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