Mụn rosacea, viêm da quanh miệng, viêm nang lông gram âm, faciei bệnh nấm da, và pseudofolliculitis • Các tổn thương Trunk có thể bị nhầm lẫn với viêm nang lông do tụ cầu, miliaria, hoặc eosinophilic viêm nang lông • Có thể được gây ra bởi các steroid tại chỗ, hít thở hoặc hệ thống | 364 Essentials of Diagnosis Treatment 15 Acne Vulgaris Essentials of Diagnosis Often occurs at puberty though onset may be delayed until the third or fourth decade Open and closed comedones the hallmarks Severity varies from comedonal to papular or pustular inflammatory acne to cysts or nodules Face neck upper chest and back may be affected Pigmentary changes and severe scarring can occur Differential Diagnosis Acne rosacea perioral dermatitis gram-negative folliculitis tinea faciei and pseudofolliculitis Trunk lesions may be confused with staphylococcal folliculitis miliaria or eosinophilic folliculitis May be induced by topical inhaled or systemic steroids oily topical products and anabolic steroids Foods neither cause nor exacerbate acne In women with resistant acne hyperandrogenism should be considered may be accompanied by hirsutism and irregular menses Treatment Improvement usually requires 4-6 weeks Topical retinoids very effective for comedonal acne but usefulness limited by irritation Topical benzoyl peroxide agents Topical antibiotics erythromycin combined with benzoyl peroxide clindamycin effective against comedones and mild inflammatory acne Oral antibiotics tetracycline doxycycline minocycline for moderate inflammatory acne erythromycin is an alternative when tetracyclines contraindicated Low-dose oral contraceptives containing a nonandrogenic progestin can be effective in women Diluted intralesional corticosteroids effective in reducing highly inflammatory papules and cysts Oral isotretinoin useful in some who fail antibiotic therapy pregnancy prevention and monitoring essential Surgical and laser techniques available to treat scarring Pearl Don t waste time continuing failing therapies in scarring acne treat aggressively if needed to prevent further scars. Reference Leyden JJ Therapy for acne vulgaris. N Engl J Med 1997 336 1156. PMID 97238758 Chapter 15 Dermatologic Disorders 365 Rosacea Essentials of Diagnosis A chronic disorder of the mid face in
