Adolescent Acne: A Stepwise Approach to Management

Iris Woodard, BSN, ANP

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(2) 

In This Article

Complications

Acne can have several complications. These can occur with or without treatment, or as a side effect of treatment:[7]

  • Gram-negative folliculitis. A pustular eruption may occur when a patient has been on extended oral antibiotic therapy. There is an overgrowth of lactose-fermenting Gram-negative bacteria, leading to superficial pustules. Treatment involves discontinuing the current antibiotic and initiating treatment with an antibiotic specific to Gram-negative bacteria.[8]

  • Localized cellulitis. Acne cysts become extremely inflamed and cause infection of the surrounding tissue. Treatment is a broad spectrum antibiotic, orally or intravenously.

  • Acne keloidalis. Individuals who have the genetic predisposition to have a keloid reaction to inflammation will develop keloids in the beard area, along the jaw line, and on the posterior scalp. Preventing acne will do much to prevent keloid formation. Injections of a low-dose steroid can be used to decrease keloids that have appeared.

  • Acne conglobata. A severe form of nodular acne that causes epithelium-lined sinus tracts. It is the most severe form of acne, with large deep nodules, cysts, abscesses, and severe scarring. Isotretinoin (Accutane) is usually required to treat this severe form of acne.

  • Hyperpigmentation. In darker-pigmented skin, inflammation will cause increased production of melanin. As acute acne lesions fade, they leave dark spots that are as cosmetically distressing as the acne itself. Several of the comedolytic preparations, when used over many months, will help improve irregular pigmentation. However, treatment should start at the lowest strength, to prevent further irritation by the topical preparation. Additionally, products containing hydroquinone (the only effective skin bleaching agent) are available both OTC at 2% strength and by prescription at 4% strength. They are applied once daily on the discolored skin. Skin discoloration will not improve if sun exposure continues, so an effective sunscreen that protects against both UVA and UVB should be used twice daily, in the morning and early afternoon.[9]

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