Acne Vulgaris
Acne vulgaris is a very common skin disease that affects relatively all individuals at least once in their lives. According to statistics, varying degrees of acne are seen in 85% of people aged 12–25, about 8% of adults aged 25–34 and 3% of adults aged 35–44. Acne vulgaris mostly occurs in adolescence and resolves within a few years. It occurs equally in men and women. Male adolescents in particular can be severely affected by the disease, and scarring can occur if it is not treated. In women, acne often continues into adulthood. Both family doctors and dermatologists see large numbers of patients with acne. Although acne vulgaris is not a life-threatening disease, it significantly affects individuals' social relationships: there are studies reporting that acne is associated with social isolation, difficulty finding work, depression and suicide. For this reason, acne treatment should be carried out in a timely manner and with appropriate methods.
Closed and Open Comedones
The initial lesions generally consist of closed and open comedones. Closed comedones are pale or skin-coloured bumps that can reach 3 mm in diameter. In about a quarter of cases they heal within 3–4 days. Open comedones, on the other hand, contain a plug in their centre that is black due to melanin. Some acne vulgaris lesions develop from comedones and some from normal-looking skin. The most common signs are red bumps, pus-filled bumps called pustules, nodules and cysts. These bumps are usually 0.5 cm or larger. Nodules can also become inflamed over time and may bleed.
In comedonal acne no inflammatory lesions are seen; mild inflammatory acne is characterised by papules and comedones, while in nodulocystic acne comedones, inflammatory lesions and nodules larger than 5 mm are seen. Scarring may occur in this clinical form.
Nodulocystic Acne
There are comedones, papules and pustules, and nodules. In this type of acne there is a risk of scarring.
Cicatricial (Scar) Tissue
When the task of granulation tissue is complete, the blood vessels disappear and the cells decrease. It leaves behind a strong tissue rich in connective tissue fibres. This is called cicatricial (scar) tissue. Surgical and burn scars on the skin are the best examples.
What Is Rosacea?
Rosacea is a skin disease that affects especially the central part of the face, such as the nose, chin, forehead and cheeks; it begins with attacks of flushing and burning and later causes persistent redness, an increase in small blood vessels (capillaries), swelling of the skin and tissue overgrowth.
Because its clinical features closely resemble acne, it is also given names such as adult acne or acne rosacea, but unlike the acne seen in young people, it is not caused by the activity of the sebaceous glands. The cause of rosacea is not fully known.
Suspected causes include:
1. Genetic predisposition: The likelihood of rosacea in family members of rosacea patients ranges from 30% to 40%. However, there is still no clear evidence of genetic transmission.
2. Infectious causes: Although not definitive, the most frequently implicated infectious agents are Helicobacter pylori (H. pylori) bacteria found in the stomach and demodex mites found on the face.
3. Environmental factors: Numerous triggering factors such as ultraviolet radiation, high temperatures (and rarely extreme cold), spicy foods, alcohol and stress play a role in the onset or flare-up of rosacea lesions.
4. Psychogenic factors: It is known that the intermittent attacks of burning and flushing in particular are often affected by changes in the patient's mood and by psychological stress. Nevertheless, psychological stress is not the definitive cause of rosacea.
5. Innate immune system: Recently, an imbalance in the innate immune system of the skin has also been discussed.
Rhinophyma
Rhinophyma, popularly referred to in Turkish as "aubergine nose", is a rare problem. It is usually seen in white-skinned people and shows itself in people in their 50s to 70s through progressive thickening of the skin of the nose, giving it an aesthetically unpleasant appearance. The skin of the nose can become very hypertrophied and, by closing the nostrils, can prevent breathing through the nose.
The actual name of the disease, rhinophyma, comes from two Greek words: rhis means nose and phyma means growth. In this disease, the skin of the nose begins to thicken and change shape from middle age onwards; severe swelling and deformity can be seen, especially at the tip of the nose. Sometimes this extends beyond the borders of the nose towards the cheeks. It is 12 times more common in men than in women. The cause is unknown; although attempts have been made to link it with certain hormonal diseases, alcoholism, certain microbes (microorganisms such as Demodex folliculorum are usually detected in the skin of the nose in this disease) and genetics, the definitive effect of such causes has not been proven.
Granulomatous Rosacea
Chronic rosacea typically follows a broad clinical spectrum consisting of oedema, flushing, telangiectasia and rhinophyma. The classical classification was standardised according to the 2002 consensus report of the Expert Committee of the American National Rosacea Society, which defined four subtypes of the disease – erythematotelangiectatic (ETR), papulopustular (PPR), ocular (OR) and phymatous rosacea (FR) – and one variant, granulomatous rosacea (GR). GR was first described by Lewandowski as a rosacea-like tuberculid. Although his patient did not have an active tuberculosis infection, Lewandowski regarded the case as a tuberculid because of a positive tuberculin reaction.
Perioral Dermatitis
Perioral dermatitis is a disease seen mostly in young women. Children and men can rarely be affected. "Perioral" refers to the area around the mouth, and "dermatitis" is used to describe the rash and irritation of the skin. In addition to a red rash, red bumps, acne-like lesions and peeling may be seen. Sometimes the acne-like findings are more prominent and the disease may be mistaken for acne (spots). The most affected areas are the upper lip, between the lines running down from the sides of the nose, and the chin. A band of healthy skin remains between the lips and the affected area. Rarely, the nose, eyes and cheeks may be affected.
How long does the disease last?
If left untreated, the disease lasts for months or years. Even with treatment the disease may recur, but after successful treatment recurrence is generally not seen.
What causes perioral dermatitis?
The exact cause of perioral dermatitis is not known. However, according to some dermatologists, this disease is a form of rosacea or of seborrhoeic dermatitis that worsens with sun exposure. Strong cortisone creams applied to the face can cause perioral dermatitis. In perioral dermatitis, cortisone creams help at first, but the condition recurs soon after they are stopped. Some moisturisers, make-up products and dental products may partly affect the disease.
Can perioral dermatitis be prevented?
There is no guaranteed way to prevent perioral dermatitis. However, applying strong cortisone creams to the face should be avoided. Use the sunscreens, cosmetics and moisturisers recommended by your doctor. Avoid using fluoridated, anti-tartar and cinnamon-flavoured toothpastes.
Are laboratory tests needed to make a diagnosis?
Most of the time tests are not needed. A dermatologist makes the diagnosis by examination. Sometimes a biopsy may be required.
How is this disease treated?
Oral tablets containing tetracycline are the most common treatment option. Treatment should last a few months to prevent recurrences. In mild cases and in pregnant women, antibiotic creams can be used. Your doctor may also give short-term cortisone treatment until the antibiotics take effect.
What should be expected from treatment?
Most patients recover within 2 months with oral antibiotic treatment. If cortisone creams are used in treatment, there may be a mild flare-up when these creams are stopped. If antibiotic treatment is stopped too early, the disease recurs.
Acne Conglobata
The follicular occlusion triad is defined as the coexistence of three of the following diseases: acne conglobata, hidradenitis suppurativa, dissecting cellulitis and pilonidal sinus. The coexistence of all four is called the follicular occlusion tetrad. Because of these symptoms, patients first present to dermatology and general surgery outpatient clinics. However, rarely, cases of follicular occlusion triad may first present to ear, nose and throat (ENT) clinics when acne conglobata is localised to the head and neck. Acne conglobata is a chronic disease characterised by folliculitis, cellulitis, nodules or sinus tracts. Hidradenitis suppurativa usually involves the axillary region and is characterised by subdermal cellulitis, sinus tracts and scarred areas resulting from a defect in the follicular epithelium. Dissecting cellulitis is a chronic disease characterised by widespread follicular lesions and dermal cellulitis on the scalp.
Because acne conglobata can be located on the head and neck, ENT doctors need to keep this syndrome in mind among the differential diagnoses when evaluating head and neck masses. When acne conglobata is widely distributed over the body, diagnosis is easier. However, when it presents in a localised area, on a background of cellulitis, as a single nodule or a single fistula opening, it must be differentiated from a dermoid cyst, branchial cyst or thyroglossal cyst.
Hidradenitis Suppurativa
Hidradenitis suppurativa is a disease that occurs particularly in areas where sebaceous and sweat glands are dense, such as both armpits, under the breasts, the neck, the groin, the inner thighs where they rub together and the anogenital region. It is also popularly known in Turkish as "köpek memesi".
How is hidradenitis suppurativa treated?
There are many treatment options for hidradenitis suppurativa. Treatment depends on the complaints and the extent of infection and lesions. For this purpose, topical and systemic antibiotics, immunosuppressive drugs, laser treatment and, in severe cases, surgical treatment methods are used.
What should be considered during treatment?
Lifestyle adjustments are important in bringing the disease under control. These include:
• Keeping the affected areas clean and dry
• Paying attention to local hygiene
• Reducing friction and moisture (avoiding synthetic and tight clothing)
• Not smoking
• Losing weight – excess weight increases the depth of skin folds, causing more friction, local irritation and bacterial growth.
• Adjusting the diet.
Drug-Induced Acne
Various drugs used topically or systemically can worsen acne vulgaris, and some can directly cause acne-like skin symptoms. The best example of this is high-dose cortisone use. Widespread red bumps appear on the trunk, shoulders and arms as early as 1–2 weeks after starting cortisone, or within about 3–6 weeks if the dose is low.
Apart from cortisone, anabolic steroids, iodide, bromide, isoniazid, lithium, hormone-containing drugs, quinine, azathioprine, rifampicin and high-dose B vitamins can also cause an acne-like skin rash.
Acne Venenata
Contact with various chemical substances causes blackheads to develop, ultimately resulting in acne venenata. Some substances well known to cause acne venenata are chlorinated hydrocarbons, petroleum products and coal tar.