Acné conglobata hemorrágico en un adulto joven. Caso clínico y revisión bibliográfica
Palabras clave:
acné conglobata, Stafilococus aureus, unidad pilosebácea, fulminate, secreción hemoatopurulentaResumen
Se presenta un paciente adulto joven de 23 años de edad con acné conglobata hemorrágico, de 6 meses de evolución, luego de una limpieza facial. Presenta dolor facial, alza térmica, malestar general, edema y deformidad; además, depresión moderada. En estas lesiones se observa pústulas profundas y abscesos por confluencia de lesiones más pequeñas y se interconectan mediante fístulas; además, se acompañan de coágulos que drenan secreción hematopurulenta al inclinar la cabeza hacia abajo y adelante.
Se diagnostica proceso infeccioso y aisla Stafilococcus aureus. Luego de realizar curaciones diarias, administrar antibiótico sistémico por vía oral y tratamiento de apoyo se logra una gran mejoría; además, se instaura tratamiento con isotreinoina durante 6 meses.
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Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. Global Alliance to Improve Outcomes in Acne. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group. J Am Acad Dermatol 2009;60(Suppl.5):S1-50.
Centers for Disease Control and Prevention. Classifications of diseases and functioning and disability. In: Classifications of diseases and functioning and disability, vol. 2008. National Center for Health Statistics; 2001 definition of disability reference. Fecha de consulta: 23 de febrero de 2009. Disponible en: http://www.cdc.gov/nchs/icd9.htm.
O’Halloran J, Miller GC, Britt H. Defining chronic conditions for primary care with ICPC-2. Fam Pract 2004;21:381-386.
Zhang JZ, Li LF, Tu YT, Zheng J. A successful maintenance approach in inflammatory acne with adapalene gel 0.1% after an initial treatment in combination with clindamycin topical solution 1% or after monotherapy with clindamycin topical solution 1%. J Dermatolog Treat 2004;15:372-378.
Thiboutot DM, Shalita AR, Yamauchi PS, Dawson C, Kerrouche N, Arsonnaud S, et al. Adapalene gel, 0.1%, as maintenance therapy for acne vulgaris: a randomized, controlled, investigator-blind follow-up of a recent combination study. Arch Dermatol 2006;142:597-602.
Fallon JD. Acne. En: Olbricht SM, Bigby ME, Arndt KA (eds). Manual of clinical problems in dermatology. Boston: Little, Brown and Co. 1992;pp.101-105.
Bowe WP, Leyden JJ, Crerand CE, Sarwer DB, Margolis DJ. Body dimorphic disorder symptoms among patients with acne vulgaris. J Am Acad Dermatol 2007;57:222-230.
Purdy S, De Berker D. Acne. BMJ 2006;333:949-953.
Fried RG, Wechsler A. Psychological problems in the acne patients. Dermatol Ther 2006;19:237-240.
Harper JC, Thiboutot DM. Pathogenesis of acne: recent research advances. Adv Dermatol 2003;19:1-10.
Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol 2003;121:20-27.
Vowels BR, Yang S, Leyden JJ. Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne. Infect Immun 1995;63:3158-3165.
Kim J, Ochoa MT, Krutzik SR, Takeuchi O, Uematsu S, Legaspi AJ, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol 2002;169:1535-1541.
Kapetanovic R, Cavaillon JM. Early events in innate immunity in the recognition of microbial pathogens. Expert Opin Biol Ther 2007;7:907-918.
Jugeau S, Tenaud I, Knol AC, Jarrousse V, Quereux G, Khammari A, et al. Induction of toll-like receptors by Propionibacterium acnes. Br J Dermatol 2005;153:1105-1113.
Kang S, Cho S, Chung JH, Hammerberg C, Fisher GJ, Voorhees JJ. Inflammation and extracellular matrix degradation mediated by activated transcription factors nuclear factor kappa B and activator protein-1 in inflammatory acne lesions in vivo. Am J Pathol 2005;166:1691-1699.
Czernielewski J, Michel S, Bouclier M, Baker M, Hensby JC. Adapalene biochemistry and the evolution of a new topical retinoid for treatment of acne. J Eur Acad Dermatol Venereol 2001;15(Suppl.):5-12.
Liu PT, Phan J, Tang D, Kanchanapoomi M, Hall B, Krutzik SR, et al. CD209(1) macrophages mediate host defense against Propionibacterium acnes. J Immunol 2008;180:4919-4923.
Trivedi NR, Cong Z, Nelson AM, Albert AJ, Rosamilia LL, Sivarajah S, et al. Peroxisome proliferator-activated receptors increase human sebum production. J Invest Dermatol 2006;126:2002-2009.
Smith TM, Cong Z, Gilliland KL, Clawson GA, Thiboutot DM. Insulin-like growth factor-1 induces lipid production in human SEB-
sebocytes via sterol response element-binding protein-1. J Invest Dermatol 2006;126:1226-1232.
Zouboulis CC, Chen WC, Thornton MJ, Qin K, Rosenfield R. Sexual hormones in human skin. Horm Metab Res 2007;39:85-95.
Zouboulis CC. The human skin as a hormone target and an endocrine gland. Hormones (Athens, Greece). 2004;3:9-26.
Wille JJ, Kydonieus A. Palmitoleic acid isomer (C16:1delta6) in human skin sebum is effective against gram-positive bacteria. Skin Pharmacol Appl Skin Physiol 2003;16:176-87.
Georgel P, Crozat K, Lauth X, Makrantonaki E, Seltmann H, Sovath S, et al. A toll-like receptor 2-responsive lipid effector pathway protects mammals against skin infections with gram-positive bacteria. Infect Immun 2005;73:4512-4521.
Boehm KD, Yun JK, Strohl KP, Elmets CA. Messenger RNAs for the multifunctional cytokines interleukin-1 alpha, interleukin-1 beta and tumor necrosis factor-alpha are present in adnexal tissues and in dermis of normal human skin. Exp Dermatol 1995;4:335-341.
Zouboulis CC, Baron JM, Bohm M, Kippenberger S, Kurzen H, Reichrath J, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol 2008;17:542-551.
Zouboulis CC, Bohm M. Neuroendocrine regulation of sebocytesea pathogenetic link between stress and acne. Exp Dermatol 2004;13(Suppl.):31-35.
Ziegler CG, Krug AW, Zouboulis CC, Bornstein SR. Corticotropin releasing hormone and its function in the skin. Horm Metab Res 2007;39:106-109.
Slominski AT, Botchkarev V, Choudhry M, Fazal N, Fechner K, Furkert J, et al. Cutaneous expression of CRH and CRH-R: Is there a ‘‘skin stress response system?’’ Ann N Y Acad Sci 1999;885:287-311.
Toyoda M, Morohashi M. New aspects in acne inflammation. Dermatology 2003;206:17-23.
Bohm M, Schiller M, Stander S, Seltmann H, Li Z, Brzoska T, et al. Evidence for expression of melanocortin-1 receptor in human sebocytes in vitro and in situ. J Invest Dermatol 2002;118:533-539.
Zhang L, Anthonavage M, Huang Q, Li WH, Eisinger M. Proopiomelanocortin peptides and sebogenesis. Ann N Y Acad Sci 2003;994:154-61.
Zouboulis CC, Seltmann H, Hiroi N, Chen W, Young M, Oeff M, et al. Corticotropin-releasing hormone: An autocrine hormone that promotes lipogenesis in human sebocytes. Proc Natl Acad Sci USA 2002;99:7148-153.
Thielitz A, Ansorge S, Bank U, Tager M, Wrenger S, Gollhick H, et al. The ectopeptidases dipeptidyl peptidase IV (DP IV) and aminopeptidase N (APN) and their related enzymes as possible targets in the treatment of skin diseases. Front Biosci 2008;13:2364-2375.
Zouboulis CC. Isotretinoin revisited: pluripotent effects on human sebaceous gland cells. J Invest Dermatol 2006;126:2154-216.
Ottaviani M, Alestas T, Flori E, Mastrofrancesco A, Zouboulis CC, Picardo M. Peroxidated squalene induces the production of inflammatory mediators in HaCaTkeratinocytes: a possible role in acne vulgaris. J Invest Dermatol 2006;126:2430-247.
Zouboulis CC. Leukotrien-antagonisten bieatopischen Erkrankungen und Akne.AktDermatol 2003;29:419-425.
Zouboulis CC, Saborowski A, Boschnakow A. Zileuton, an oral 5-lipoxygenase inhibitor, directly reduces sebum production. Dermatology 2005;210:36-38.
Alestas T, Ganceviciene R, Fimmel S, Muller-Decker K, Zouboulis CC. Enzymes involved in the biosynthesis of leukotriene B4 and prostaglandin E2 are active in sebaceous glands. J Mol Med 2006;84:75-87.
Papakonstantinou E, Aletras AJ, Glass E, Tsogas P, Dionyssopoulos A, Adjaye J, et al. Matrix metalloproteinases of epithelial origin in facial sebum of patients with acne and their regulation by isotretinoin. J Invest Dermatol 2005;125:673-684. Orozco B, Campo ME, Anaya LA, et al. Rev Asoc Colomb Dermatol 2011;19:129-157. www.revistasocolderma.com 153
Domonkos, Arnold y Odom, Andrews. Tratado de Dermatología, 3ra. ed. 1985;pp.300-323 Salvat Ed.
Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, Levy M, Lucky A, et al. (mayo de 2013). Evidencebased recommendations for the diagnosis and treatment of pediatric acne. Pediatrics (en inglés) 131 (Suppl3):S163-186. doi:10.1542/ peds.2013-0490B. PMID 23637225.
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Derechos de autor 2020 Juan Arellano, Jenny Jaramillo
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
