Acne tropicalis

Sulzberger et al. 1946

Occurrence of acneiform lesions in humid (tropical) environments.

Papules, pustules, comedones on the face.

Anamnesis

Clinical picture

Cause treatment:

Other like acne vulgaris:

Consensus therapy algorithm of the German Acne Guidelines Group

Source: Nast, A. (2016). S2 guideline: treatment of acne. Awmf.org. Retrieved 1 June 2016, from http://www.awmf.org/leitlinien/detail/ll/013-017.html

- Topical therapy

• Cleansing wash solutions

• Medicinal camouflage

• Tretinoin (Airol® ) cream / lotion 0.05% 1-2x tgl.

• Adapalene (Differin®) cream / gel 1x tgl. in the evening after prior cleansing of the skin

• Erythromycin (Aknilox®)- gel 4% 2x tgl., after 2 months change to Aknilox®- gel 2%

• Clindamycin (Dalacin T®)- emulsion / solution 2x tgl.
• To avoid resistance always joint prescription with Procutol® skin wash lotion 1x tgl.

• Benzoyl peroxide (Lubexyl®) emulsion 2x tgl. apply like soap, leave on for 1-2 minutes.
• CAVE: Discolouration of clothing.

• Apply undecylenic acid (Lubex®) Extra Mild liq 1x tgl. like soap
• Azelaic acid (Skinoren®)- gel / cream 1-2x tgl.

• Adapalene / benzoyl peroxide (Epiduo®) 0.1, 0.25 % gel 1x tgl.

• Benzoyl peroxide / Clindamycin (Duac®) acne gel 1x tgl. in the evening.

  - Radiation therapy

• Short-term UVB or UVA/UVB.

  - Systemic therapy

• Doxycycline® p.o. 100 mg 2x tgl. for 14-21 days
• Oracea® p.o. 40 mg 1x tgl.
• Minocycline (Minac®) p.o. 50 mg 2x tgl.
• Lymecycline (Tetralysal®) p.o. 300 mg 1x tgl. for max. 12 weeks
• Erythromycin (Erythromycin®) p.o. 500 mg 4x tgl. for 7-14 days

• Isotretinoin p.o. 10 mg 1x tgl. can lead to reduction of seborrhoea.
• We at the USZ recommend low-dose therapy. The effect/side-effect ratio is clearly superior to the dosage recommended in the specialist information.

• Hormones - by gynaecologists
• Oestrogens
• Ethinylestradiol
• Antiandrogens
• Cyproterone acetate
• Chlormadinone acetate
• Megestrol acetate

• Chemical Peels
• AHA (Alpha Hydroxy Acid)
• Superficial, chemical peel
• Maintenance therapy for superficial postinflammatory hyperpigmentation
• To reduce comedones
• Salicylic acid peels
• Postacne-Conditions with follicular keratinisation
• Postinflammatory hyperpigmentation
• Superficial scarring
• Trichloroacetic acid (TCA)
• Focal application for single, deep, worm-like scars

• Pregnancy
• In case of need for treatment indicated:
• Benzoyl peroxide
• Erythromycin
• Azelaic acid
• Systemic

  In the 1st trimester systemic therapy may be discussed, from the 2nd trimester recommended.

• Erythromycin (first-line agent)

• Glucocorticoids (for severe relapses) possible from the second trimester.
• Data: with multiple administration of corticosteroids (until week 32) (11.4mg / week) à ↑ risk of respiratory distress syndrome
• Small amounts in breast milk à but harmless!

• Erythromycin (not in breastfeeding).

• Zinc sulphate 200 mg or zinc gluconate 200 mg (= 30 mg elemental zinc) for a maximum of 3 months.
• If taken chronically à risk of copper deficiency (microcytic anaemia)
• Always discuss with the gynaecologist in charge

Plewig G., Kligman A.M. (1994) Acne tropicalis (Tropenakne). In: Akne und Rosazea. Springer, Berlin, Heidelberg, https://doi.org/10.1007/978-3-642-57960-8_26