[Dermatology meeting of Paris. 7-10 December 1994. Abstracts].

In 1994 acne should be a very treatable disorder. However there are a significant number of patients who do not respond as well to therapy as they ought. Compliance is an important reason for poor response. Inappropriate therapy is another common reason. An increasing problem are patients with resistance of P. acnes to commonly used antibiotics; 39% of our patients have such resistance. Within this sub-group the commonest antibiotics causing problems are Erythromycin and Clindamycin (69%). Resistance is seen in 20% of such subjects to Tetracycline and Vibramycin and resistance to Trimethoprim is 12%. Multiple resistance is 14%. This is an increasing problem and unless attention is given to this problem by the year 2,000 we may have very few safe and successful antibiotics. Minocycline is rarely associated with resistance. Some patients have no resistance and may have a high sebum excretion; this will dilute what otherwise could be effective therapy. Such patients ought to be given high dose antibiotics such as Minocycline 200 mgs per day, plus appropriate topical therapy. Dianette plus 50- 100 mg cyproterone remains an alternative therapy in females. Some patients will fail to respond with these regimes and require Isotretinoin. Patients who require oral Isotretinoin are those with non-responding moderate acne, patients who scar, plus patients with unusual but specific problems. These include Acne Fulminans, Rosacea Fulminans, Acne Conglobata, Gram-negative folliculitis, Gross Seborrhoea, Dysmorphophobia, Mature Acne and Aperts Syndrome. The choice of dose varies, often according to personal experience and cost. Most physicians prescribe 0.5-1.0 mg/day for 4 months. Fifteen percent require 5-12 months therapy. Frequent reasons for prolonged therapy are macrocomedones and polycystic ovary syndrome. Relapse post therapy occurs in 30%; relapse after 3 years is unusual. Repeat doses can be given. The results are predictive and successful. The treatment of certain troublesome side effects also will be discussed as will the use of Isotretinoin in systemic disease. Isotretinoin orally is so effective that it ought to be given sooner rather than later to minimise scarring about which still only a little can be done to help the patient.