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the pathogenesis of acne vulgaris. Exp Dermatol. 2009;18:833-841. 15. Smith TM, Gilliland K, Clawson GA, Thiboutot D. IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway. J Invest Dermatol. 2008;128:1286-1293. 16. Crave JC, Lejeune H, Brebant C, Baret C, Pugeat M. Differential effects of insulin and insulin-like growth factor-1 on the production of plasma steroid-binding globulins by human hepatoblastoma-derived (Hep G2) cells. J Clin Endocrinol Metab. 1995;8:1283-1289. 17. Ben-Amitiai D

review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs. 1991;41(5):780-798. 9. Gollnick HP, Graupe K, Zaumseil RP. Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies. J Dtsch Dermatol Ges. 2004;2(10):841-847. 10. Iraji F, Sadeghinia A, Shahmoradi Z, Siadat AH, Jooya A. Efficacy of topical azelaic acid gel in the treatment of mild-moderate acne vulgaris. Indian J Dermatol Venereol Leprol. 2007;73(2):94-96 11. Dréno B, Fischer TC, Perosino E

References 1. Cunliffe WJ, Gould DJ. Prevalence of facial acne vulgaris in late adolescence and in adults. Br Med J. 1979;1(6171):1109-10. 2. Ramos-e-Silva M, Ramos-e-Silva S, Carneiro S. Acne in women. Br J Dermatol. 2015;172(1):20-6. 3. Seirafi H, Farnaghi F, Vasheghani-Farahani A, Alirezaie NS, Esfahanian F, Firooz A, et al. Assessment of androgens in women with adultonset acne. Int J Dermatol. 2007;46(11):1188-91. 4. Kaur S, Verma P, Sangwan A, Dayal S, Jain VK. Etiopathogenesis and therapeutic approach to adult onset acne. Am J Clin Dermatol. 2006; 7

References 1. Lello J, Pearl A, Arroll B. Prevalence of acne vulgaris in Auckland senior high school students. N Z Med J 1995;08:287-9. 2. Gollnick H,Cunliffe W, Berson D, et al. Management of acne: a report from Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003;49(1 Suppl):S1-37. 3. Kubba R, Ajaj AK, Thappa DM, et al. Acne in India: guidelines for management-IAA consensus document. Genetics in acne. Indian J Dermatol Venereol Leprol 2009;75(Suppl 1):S4. 4. Cunliffe WJ, Gollnick HPM. Acne: diagnosis and management. London: Martin Dunitz; 2001.p

. Teenager’s life quality. Revista cubana de pediatría 2010;82(4): 112-6. 9. Argote A, Mora O, Gonzalez L, Zapata J. Phisiophatological aspects of acne. Rev Asoc Colomb Dermatol 2014;22:200-208. 10. Tompson A. Acne. JAMA 2012;313(6):640-641. 11. Bhambri S, Del Rosso JQ. Pathogenesis of acne vulgaris: recent advances. J drugs dermatol 2009;8:615-618 12. Kaminsky A, Florez-White M, Arias MI. Acne clasification: Ibero-american consensus, 2014. Med cutan iber lat am 2015;43(1):18-23. 13. Orozco B, Campo ME, Anaya LA et al. Colombian guides for the treatment of acne: a revision

Abstract

Periungual pyogenic granuloma-like lesions are not uncommon side effects of isotretinoin therapy, but these cases are relatively infrequently reported. Excessive granulation tissue appeared in two patients receiving oral isotretinoin therapy for severe acne. Once isotretinoin was discontinued, the outgrowths resolved spontaneously in both patients. It is probably an idiosyncratic reaction to isotretinoin which renders the skin more susceptible to extracellular matrix and blood vessel formation. Moreover, similar lesions may be observed particularly with newer targeted therapies, such as inhibitors of epidermal growth factor receptor (EGFR) and mitogen-activated protein kinase kinases (MEKs). EGFR inhibitors associated painful periungual inflammation (paronychia), which often arises from the nail wall during newer targeted therapies, has been classified in the third major group of dermatologic toxicity. Cutaneous toxicity may be interpreted as a stress response that affects epidermal homeostasis. In the cell, stress signals are transmitted to effectors which then produce an inflammatory response.

In conclusion, paronychia and excessive granulation tissue in the nail folds are not uncommon side effects of oral retinoids. It is therefore particularly important for practicing dermatologists to be aware that the best management approach is drug discontinuation.

Abstract

Acne necrotica is a rare disease, characterized by repeated cropping of inflammatory papules and papulo-pustules, which rapidly necrotize and leave varying degrees of varioliform scars that may lead to cicatricial alopecia when terminal hair-bearing sites are involved. In early lesions, pathology shows necrotizing lymphocytic folliculitis. We report a 63-year-old male patient with chronic, relapsing, umbilicated and centrally necrotic erythematous papules and papulo-pustules involving the frontal hairline area, face, and neck. Histopathology showed epidermal spongiosis and lymphocytic exocytosis, extensive necrosis and destruction of the follicular epithelium, a dense diffuse lymphohistiocytic infiltrate and necrosis of the perifolicular dermis. The diagnosis of acne necrotica was made based on the correlation of clinical and histopathological findings. A complete clinical remission was achieved with topical erythromycin and benzoyl peroxide.

dermal/transdermal delivery. Ther Deliv. 2010;1:109-131. 4. Feneran AN, Kaufman WS, Dabade TS, Feldman SR. Retinoid plus antimicrobial combination treatments for acne. Clin Cosmet Investig Dermatol. 2011;4:79-92. 5. Kobayashi M, Nakagawa T, Fukamachi K, Nakamura M, Tokura Y. Efficacy of combined topical treatment of acne vulgaris with adapalene and nadifloxacin: a randomized study. J Dermatol. 2011;38:1163-1166. 6. Takigawa M, Tokura Y, Shimada S, Furukawa F, Noguchi N, Ito T. Acne Study Group. Clinical and bacteriological evaluation of adapalene 0.1% gel plus

Dermatological Treatment. Dermatol Ther (Heidelb). 2015;5:37–51 14. Zhang H, Liao W, Chao W et al - Risk factors for sebaceous gland diseases and their relationship to gastrointestinal dysfunction in Han adolescents. J Dermatol. 2008;35:555-61 15. Silverberg JI, Silverberg NB. - Epidemiology and extra-cutaneous comorbidities of severe acne in adolescence: A US population-based study. Br J Dermatol. 2014 May;170(5):1136-42. 16. Al Hussein SM, Al Hussein H, Vari CE, et al - Diet, Smoking and Family History as Potential Risk Factors in Acne Vulgaris – a Community-Based Study

REFERENCES 1. Kornetov N.A. Clinical anthropology – methodological basis for a holistic approach in medicine. Proceedings of the international conference “Current issues and achievements of modern anthropologists”, Novosibirsk, 2006. 2. Nikitiuk B.A., Moroz V.M., Nikitiuk D.B. Theory and practice of integrative anthropology . Essays. Kiev-Vinnitsa: Zdorov’ya, 301, 1998. 3. Samtsov A.V. Acne and acneforme dermatosis . Monograph M. : OOO “YUTKOM”, 288, 2009. 4. Szabó K., Kemény L. Studying the genetic predisposing factors in the pathogenesis of acne vulgaris