Pustular acne, staphyloderma and its treatment with tolbutamide.


THE PROBLEM OF ACNE, speaking pathologically, is not very serious, but if we consider the total picture including psychological ramifications which affect the social life of the individual, it becomes a disease of major importance. This aspect has been well documented by Marshall.' The treatment of acne is not a simple "magic bullet" affair. The specific systemic measures usually employed in addition to local therapy depend upon the seriousness of the skin condition. These additional measures include hormone therapy, antibiotic therapy, dietary control, vitamin supplements, ultraviolet and x-ray therapy, and administration of toxoids and vaccines. Local and x-ray therapy is aimed at combating sebaceous gland hyperplasia and seborrhcea, and eradicating follicular plugging to prevent new foci. In severe cases of acute pustular acne, local therapy alone is of little value. The underlying predisposing causes, whether hormone disturbances or metabolic defects, must be taken into consideration. Antibiotics are of doubtful value topically but are of value systemically in some forms of acne.2' 3 We agree with other investigators that vitamin A has a definite value, particularly in the comedopapular type of acne. Clinical evidence of vitamin A deficiency, such as follicular keratosis about the elbows and knees of certain patients, can often be found. We use Aquasol A, 50,000 units once daily for three months. We often combine 50,000 units of synthetic vitamin A with 500 mg. of vitamin C. The role of vitamin A in the treatment of acne has received wide study.6 When acne is characterized by comedo formation and numerous small papules (especially when the comedo phase is excessive), we employ a dosage of 100,000 units of vitamin A per day for 3-5 months. The role of hormones in the management of acne has been and still is controversial, but again good results have been achieved by us, as by many workers,4 with the use of cestrogenic substances. It has been shown that the urinary excretion of 17-ketosteroids is increased in patients receiving ACTH therapy. In patients with Cushing's disease, in persons before puberty, and in eunuchs, 17-ketosteroid excretion is low and acne is not present. The excretion level rises at puberty, especially with the development of secondary sex characteristics, and at this time acne manifests itself. It has also been shown that the excretion of 17-ketosteroids is

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Cite this paper

@article{Cohen1958PustularAS, title={Pustular acne, staphyloderma and its treatment with tolbutamide.}, author={J. L. Cohen and Aanon D Cohen}, journal={Canadian Medical Association journal}, year={1958}, volume={80 8}, pages={629-32} }