The goals of pharmacotherapy and surgical approaches are to reduce morbidity and to prevent complications. They may be combined.  For example, acne conglobata can be treated by fractional laser after carbon dioxide laser abrasion of cysts combined with topical tretinoin therapy.  The tumor necrosis factor-alpha antagonistadalimumab may represent another option for acne conglobata resistant to conventional therapies. 
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Prednisone is a synthetic adrenocortical steroid with predominantly glucocorticoid properties. It ddecreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reducing capillary permeability. It stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.
Corticosteroids act as potent inhibitors of inflammation. They may cause profound and varied metabolic effects, particularly in relation to salt, water, and glucose tolerance, in addition to their modification of the immune response of the body.
Retinoid-like Agents, Topical
Vitamin A derivatives stimulate cellular retinoid receptors and help normalize keratinocyte differentiation and are comedolytic. In addition, they have anti-inflammatory properties. Oral isotretinoin also reduces sebum production in the skin.
Isotretinoin is an oral agent that treats serious dermatologic conditions. Isotretinoin is the synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to beta-carotene. It decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization. Effective March 1, 2006, the FDA requires that prescribers of isotretinoin, patients who take isotretinoin, and pharmacists who dispense isotretinoin all must register with the iPLEDGE system.
Tretinoin topical is structurally related to vitamin A. It may be helpful for recalcitrant disease, but recurrence is common. Long-term, low-dose therapy may be suitable for selected patients. It may cause skin irritation in some patients. Also, it has been linked to the promotion of angiogenesis; however, it has not demonstrated increased telangiectasias. Tretinoin topical also inhibits microcomedo formation and eliminates lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as creams and gels.
Therapy must be comprehensive and cover all likely pathogens in the context of the clinical setting. Antibiotic selection should be guided by blood culture sensitivity whenever feasible.
Doxycyline treats infections caused by susceptible gram-negative and gram-positive organisms. It inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. The brand name 150-mg Doryx is enteric coated, to reduce gastrointestinal adverse effects.
Minocycline treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species. The brand name Solodyn is an extended-release formulation indicated for acne and prescribed as a weight based 1-mg/kg dose per day. The minocycline dose should be lowered in patients with renal impairment.
Tetracycline inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunit(s). Tetracycline has anti-inflammatory activity. One may administer 250-500 mg orally twice daily.
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