Case Reports of Acne and Homeopathy

Background: Acne vulgaris is a self-limiting disorder of the pilosebaceous unit. The aesthetic aspect of the disorder may provoke depression and diminish the quality of life. A number of agents are used for acne treatment, e.g., retinoids, antibiotics, benzoic acid, azelaic acid, and hormones. These agents have side-effects, sometimes severe ones. Case Reports: Presented are 2 cases of severe acne treated with individualized homeopathic medicines. Both patients were treated using the classical method of homeopathy, i.e., a single medicine based on the patient's individual characteristics was prescribed. The cases were documented photographically at onset and during the course of treatment. Both patients went into remission following treatment, and long-term follow-up suggested that the therapy remained efficacious long after cessation of treatment. No significant side effects were noted. Conclusions: Homeopathic medicines may be useful as stand-alone treatment of patients with severe acne vulgaris. A case series suggested a remission rate of more than 80% using individualized homeopathic treatment. The treatment remained efficacious long after cessation and is not accompanied by significant side-effects. It is to be hoped that this presentation will stimulate research interest into homeopathic medicines as stand-alone or adjunct treatments of acne.

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Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Journal of Fatima Jinnah Medical University ◽

10.37018/xqbw1463 ◽

2020 ◽

Vol 14 (2) ◽

pp. 87-90

Author(s):

Sadaf Amin Chaudhry ◽

Nadia Ali Zafar ◽

Rabia Hayat ◽

Ayesha Noreen ◽

Gulnaz Ali ◽

...

Keyword(s):

Side Effects ◽

Therapeutic Option ◽

Acne Vulgaris ◽

Treatment Options ◽

Tertiary Care ◽

Poor Response ◽

Global Assessment Scale ◽

Severe Acne ◽

Hematologic Profile

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

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Long-Term Follow-Up after Radiotherapy of Hidradenitis Suppurativa

Dermatology ◽

10.1159/000517252 ◽

2021 ◽

pp. 1-7

Author(s):

Jurr Boer

Keyword(s):

Total Dose ◽

Hidradenitis Suppurativa ◽

Early Stage ◽

Case Reports ◽

Case Series ◽

Postal Survey ◽

Long Term Follow Up ◽

Late Treatment

Background: Patients with hidradenitis suppurativa (HS) are still often disappointed with the current treatments offered and there is a clear demand for more effective options. Since the late 1990s there has been a revival in the use of radiotherapy (RT) for different benign diseases, including HS. During the past 20 years one case series and some scattered case reports have described promising results of RT. Objectives: To evaluate the long-term efficacy of RT in early-stage HS. Methods: A postal survey-based long-term follow-up with simple factual questions of partly retrospective and partly contemporary characteristics was performed. Sixty-four patients (96 axillae), diagnosed with mild to moderate HS were irradiated with a orthovoltage unit with 100 kV, 3 mm Al or 200 kV, 0.5 Cu filtering, respectively. Four to six biweekly fractional doses ranging from 0.75 to 1 Gy up to a total dose of 6 Gy in one series, and in chronic cases followed by four daily fractions of 2 Gy up to a total dose of 14 Gy, were given. Late treatment toxicity and the rate of remission of the disease were evaluated. Results: The overall response rate of the survey was 64.1% with 40.6% (26/64) valid, complete questionnaires. In total, 40 axillae were irradiated in these 26 patients. After a median follow-up of 40 years (range 32–52) complete remission of the lesions occurred in 34 of the 40 sites (85%). None of the 26 patients with 40 irradiated sites reported adverse effects at the time of the survey. Conclusions: RT appears to be an effective treatment for early and mild HS in the majority of patients. In this case series, no side effects were reported after a median follow-up period of 40 years.

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Nevus Lipomatosus Superficialis Unseen or Unrecognized: A Report of Eight Cases

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2013.12125 ◽

2013 ◽

Vol 17 (5) ◽

pp. 335-339 ◽

Cited By ~ 5

Author(s):

Muthu Sendhil Kumaran ◽

Tarun Narang ◽

Sunil Dogra ◽

Uma Nahar Saikia ◽

Amarinder Jit Kanwar

Keyword(s):

Treatment Outcome ◽

Health Care Providers ◽

Case Reports ◽

Case Series ◽

Care Providers ◽

Reticular Dermis ◽

Disease Characteristics ◽

Long Term Follow Up

Background: Nevus lipomatosus superficialis (NLS) is a unique developmental anomaly or nevoid form of lipoma characterized by the ectopic presence of mature adipocytes in reticular dermis. The condition is rare; apart frrom isolated case reports, there are no large case series dealing with the clinicoepidemiologic characteristics and posttreatment long-term follow-up in patients with NLS and little published information on treatment outcome. Objective: To study the clinicoepidemiologic characteristics and long-term posttreatment follow-up in patients with NLS. Methods: This was an 11-year retrospective study analyzing disease characteristics and treatment outcome in eight patients with NLS. Results: There were eight (six males, two females) patients with NLS, of whom three were children. The classic variant of NLS was the predominant presentation. One patient demonstrated a combination of both classic and solitary variants. Most patients, especially those with solitary variants, were commonly misdiagnosed before presenting to us. Four patients, including two with the solitary variant, one each with the classic and the combined type, underwent surgical resection without any recurrence over 8 years of follow-up. Conclusions: The rare nature of the disorder, which is commonly misdiagnosed, and the absence of long-term follow-up data prompted us to share our experience about NLS to increase its awareness among health care providers.

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Pure Red Cell Aplasia and Other Haematological Diseases Associated With Thymoma: A Case Series and Systematic Review

Frontiers in Medicine ◽

10.3389/fmed.2021.759914 ◽

2021 ◽

Vol 8 ◽

Author(s):

Chih-Chieh Yen ◽

Wei-Li Huang ◽

Sin-Syue Li ◽

Ya-Ping Chen ◽

Yau-Lin Tseng ◽

...

Keyword(s):

Systematic Review ◽

Autoimmune Diseases ◽

Large Scale ◽

Remission Rate ◽

Case Reports ◽

Case Series ◽

Pure Red Cell Aplasia ◽

Red Cell ◽

Good’S Syndrome ◽

Red Cell Aplasia

Background: Thymoma-associated haematological diseases (HDs), such as pure red cell aplasia (PRCA) and Good's syndrome, are extremely rare, and due to the paucity of large-scale studies, the characteristics, remission after thymectomy, and long-term evaluation remain undetermined.Methods: We retrospectively assessed patients with thymoma and associated HDs from Jan 2005 to Dec 2020. All patients received thymectomy and/or additional treatments for HDs. A comparison with thymoma-associated myasthenic gravis (MG), and a systematic review from PubMed/MEDLINE and Embase were conducted.Results: In the median follow-up of 56 months, 130 patients were enrolled. Patients with thymoma-associated MG (n = 46) and HDs [n = 8; PRCA (n = 5), PRCA and Good's syndrome (n = 2) and autoimmune haemolytic anaemia (n = 1)] were evaluated. Patients with MG had a significantly higher remission rate after thymectomy (50 vs. 17%; p = 0.0378) as compared to those with other autoimmune diseases. Two of seven patients with PRCA experienced remission with thymectomy alone, and an additional two patients achieved remission with thymectomy plus immunosuppressive therapy (IST). In the systematic review, 60 studies (case reports, n = 46; case series including the present study, n = 14) were evaluated. Forty-four percent of patients were diagnosed with PRCA after thymoma, and 61% achieved remission with thymectomy plus IST; however, Good's syndrome was unaffected.Conclusions: Our study indicates that patients with thymoma-associated autoimmune diseases other than MG have a lower remission rate than those with MG. Remission of thymoma-associated PRCA can be achieved by thymectomy and IST. This study provides insight into extremely rare but puzzling autoimmune manifestations.

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Is Oral Omega-3 Effective in Reducing Mucocutaneous Side Effects of Isotretinoin in Patients with Acne Vulgaris?

Dermatology Research and Practice ◽

10.1155/2018/6974045 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Mina Mirnezami ◽

Hoda Rahimi

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Acne Vulgaris ◽

Control Group ◽

Case Group ◽

Omega 3 ◽

Double Blind ◽

Severe Acne ◽

Double Blind Clinical Trial ◽

And Control

Background. Acne vulgaris is an inflammatory disease of pilosebaceous units which may cause permanent dyspigmentation and/or scars if not treated. Isotretinoin is recommended in the treatment of recalcitrant or severe acne, but it is associated with common adverse effects that frequently result in patients incompliance and discontinuation of the drug. The present study was designed to assess the efficacy of oral omega-3 in decreasing the adverse effects of isotretinoin. Materials and Methods. In this randomized double-blind clinical trial, a total of 118 patients with moderate or severe acne were randomly divided into two (case and control) groups. The control group was treated with isotretinoin 0.5 mg/kg, and the case group was treated with the same dose of isotretinoin combined with oral omega-3 (1 g/day). The treatment was lasted for 16 weeks and mucocutaneous side effects of isotretinoin were recorded and compared between the two groups in weeks 4, 8, 12, and 16. Results. Cheilitis (at weeks 4, 8, and 12), xerosis, dryness of nose at all weeks, and dryness of eyes (at week 4) were less frequent in the group that received isotretinoin combined with oral omega-3 compared to the group that received isotretinoin alone. Conclusion. Administration of oral omega-3 in acne patients who are receiving isotretinoin decreases the mucocutaneous side effects of isotretinoin. This trial is registered with IRCT201306238241N2.

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Assessment of Plasma Malondialdehyde in Acne Patients on Isotretinoin Therapy

QJM ◽

10.1093/qjmed/hcaa046.007 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

H M A Saleh ◽

K M A Alzawahry ◽

R E M Gad

Keyword(s):

Oxidative Stress ◽

Lipid Peroxidation ◽

Side Effects ◽

Serum Level ◽

Liver Function ◽

Lipid Profile ◽

Acne Vulgaris ◽

Liver Function Tests ◽

Severe Acne ◽

Function Tests

Abstract Background Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit that affects predominantly adolescents and young adults. Oral isotretinoin is a highly effective treatment agent for patients with nodulocystic acne and moderate to severe acne resistant to conventional therapy, isotretinoin might have side effects of oxidative stress and lipid peroxidation. . Malondialdehyde is the end product of lipid peroxidation and is a good marker of free radical-mediated damage and oxidative stress. Objective The purpose of this study to estimate malondialdehyde level in patients on Isotretinoin treatment for moderate to severe acne and compare them with healthy control group. Patients and Methods The case-control study was conducted at Ain. Shams University Faculty of Medicine, Egypt, from October 2017 to April 2017, and comprised male or non-pregnant female patients more than 18 years of age. 88 participants were included in the study; 44 cases, categorized by the Global Evaluation Acne (GEA) into 22 patients with moderate acne vulgaris and 22 patients with severe acne in comparison to equal healthy matching group. Isotretinoin was started in a dosage of 0.5mg/kg/day, and1.0mg/kg/day in patients with moderate and severe acne vulgaris respectively. Malondialdehyde, liver function tests, lipid profile and CBC were tested at the baseline for all participants and after 3 months for the patients who started isotretnoin therapy. Results In the current study, the mean baseline level malondialdehyde among all cases was 141.39 µmo1/m1±88.90, (range: 34.5 -360) and in controls it was 40 [µmo1/m1 ±11.3, (range: 9.5-90.4) this difference was statistically highly significant (P = 0.001). There was highly significant difference in malondialdehyde serum level (p = 0.0001) among all cases after 3 months of isotretnoin therapy, also there was a significant increase in MDA serum level among moderate cases (p = 0.021) and highly significant increase of MDA in severe cases (p=.001).ALP, ALT, serum cholesterol and triglyceride significant increases were seen in all cases. Conclusion low dose isotretinoin seems to have less side effects on basic laboratory data such as CBC, liver function tests, lipid profile and Malondialdehyde serum levels than high dose.

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Standard daily dosage versus pulse dosage of Isotretinoin in acne vulgaris: A hospital based comparative study

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v7i2.21598 ◽

2018 ◽

Vol 7 (2) ◽

pp. 68-74

Author(s):

Eliz Aryal ◽

SB Shrestha ◽

G Pokhrel ◽

S Bhattarrai

Keyword(s):

Side Effects ◽

Comparative Study ◽

Acne Vulgaris ◽

College Teaching ◽

Poor Response ◽

Lumbosacral Spine ◽

Daily Regimen ◽

Severe Acne ◽

Pulse Dose ◽

Oral Isotretinoin

Background: Acne is a multi factorial disease ranging from a couple of comedones and pustules to severe nodulocystic fulminantacne. Isotretinoin (13-cis-retinoic-acid) drug affect all the factors involved in pathogenesis of acne and approved by Food and Drug Administration in 1982. It causes several dose-dependent mucocutaneous and systemic side effects and cost effectObjective: To assess and compare the efficacy and tolerability of two regimens (daily conventional and pulse dose) in moderate to severe acne vulgaris.Methodology: This is a prospective randomized comparative study in moderate to severe acne vulgaris in Kathmandu Medical College Teaching Hospital. The patients were randomly divided into two groups (A and B). In group A conventional dose of 20 mg of oral isotretinoin was given daily and in group B 20 mg of oral isotretinoin was given thrice (Pulse Dosage in alternate day) in a week for six months. The baseline haematological, biochemical and radiological (lumbosacral spine) was compare on first, third and six month.Results: Seventy-four patients were enrolled with mean age of 21.73 years. Patients with daily regimen show good response throughout the therapy for six months (1st, 3rd 6th months), where as those in pulse therapy show moderate to poor response during early month and gradually improve by end of sixth month. At end of sixth month, both the regimen show good response and was statistically significant.Conclusion: However, the pulse dose regimen makes the treatment more acceptable, for patients with acne than the classical standard daily regimen, in term of side effects and cost effectiveness and patient compliance. Journal of Kathmandu Medical CollegeVol. 7, No. 2, Issue 24, Apr.-Jun., 2018, Page: 68-74

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A case series of efavirenz induced gynaecomastia

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20212412 ◽

2021 ◽

Vol 8 (7) ◽

pp. 984

Author(s):

Balakrishna Teli ◽

Sneha Biradar ◽

Sheshan V. S.

Keyword(s):

Side Effects ◽

Hiv Infection ◽

Side Effect ◽

Case Reports ◽

Case Series ◽

Drug Adherence ◽

Resource Limited Settings ◽

Highly Active ◽

Resource Limited ◽

Haart Therapy

The prognosis of HIV infection has significantly changed following the introduction of highly active anti-retroviral therapy by reducing AIDS related morbidity and mortality. At the same time, HAART is documented for its side effects. Gynaecomastia is a less documented side effect of a commonly used ART drug efavirenz. There are only few case reports of HAART-induced gynaecomastia in resource limited settings. Initially gynaecomastia related to HAART in HIV patients was thought due to lipodystrophy and was termed as pseudogynaecomastia. Later, few case reports of efavirenz related gynaecomastia were published after ruling out other causes of gynaecomastia. All other causes of gynaecomastia were ruled out in our patients too. The incidence of gynaecomastia is increasing in men with HIV on HAART therapy, proper identification and management will promote better drug adherence. The present study presented a series of two cases that developed ultrasound confirmed gynaecomastia following efavirenz containing HAART.

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Azithromycin Pulse Therapy with Oral Doxycycline in the Treatment of Acne Vulgaris, a Randomized Group Study

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i23b31411 ◽

2021 ◽

pp. 1-9

Author(s):

C. Sadhana ◽

N. S. Muthiah

Keyword(s):

Adverse Event ◽

Side Effects ◽

Acne Vulgaris ◽

Pulse Therapy ◽

Response To Treatment ◽

Antibiotics Resistance ◽

Once Daily ◽

Severe Acne ◽

Group I ◽

Systemic Antibiotics

Acne vulgaris is a common dermatological problem. The choice of proper treatment is determined by the severity and extent of acne. Moderate to severe acne vulgaris cases respond well to systemic antibiotics. Antibiotics execute their anti-propionic bacterium effect by inhibiting the bacterial growth and colonization of pilosebaceous glands and thus further inflammation is prevented. The efficacy and possible side effects of various oral antibiotics has been the subject of numerous studies for at least the last twenty years in an effort to understand, which products are likely to produce better efficacy with least possible side effects. The new emerging problem is antibiotics resistance to propionic bacterium. There has been a constant increase in search of safe medications to overcome the side effects and resistance of existing formulations for the treatment of acne vulgaris. The study duration was 8 weeks. A total of 200 study participants of both sexes with complaints of acne vulgaris were included in the study and randomized into two groups. Group I (100 study subjects) – 500 mg Azithromycin once daily for three consecutive days in a week for 2 months and Group II (100 study subjects) –100 mg Doxycycline once daily for 2 months. After doing initial laboratory tests treatment was initiated. Three scheduled visits – Baseline, at the end 4th week and at the end of study were done and the response to treatment was evaluated. The efficacy of the drugs was assessed by the change in grading of acne from baseline and at follow up visits. Doxycycline was found to be better than azithromycin pulse therapy in reducing acne severity. During the visits gastrointestinal, dermatological and other side effects were also noted and recorded. Adverse event profile of both the drugs showed that there was no non- compliance incidence due to adverse event. But the number of adverse events was higher in doxycycline group.

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Long-term Efficacy of Rituximab Treatment in Thrombotic Thrombocytopenic Purpura

European Oncology & Haematology ◽

10.17925/eoh.2011.07.02.143 ◽

2011 ◽

Vol 07 (02) ◽

pp. 143

Author(s):

Jens M Chemnitz ◽

Michael Hallek ◽

Christof Scheid ◽

◽

...

Keyword(s):

Plasma Exchange ◽

Thrombotic Thrombocytopenic Purpura ◽

Case Reports ◽

Therapeutic Option ◽

Case Series ◽

Current Data ◽

Thrombocytopenic Purpura ◽

Long Term Follow Up

The use of therapeutic plasma exchange has reduced mortality rates in thrombotic thrombocytopenic purpura (TTP) from 90 to 1020%. However, TTP is a potentially lethal disorder, and management of patients with TTP refractory to plasma exchange or frequently recurrent disease is difficult. In those cases, rituximab might be a therapeutic option, although current data are based primarily on case reports and smaller case series. While initial response rates to rituximab are reported to be high, long-term follow-up data of patients treated with rituximab are rare; however, it is important to estimate the safety and benefit of this treatment. In this article we focus on current experience with rituximab in the treatment of TTP, including recent results with long-term follow-up.

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