Very Severe (4th Grade) Closed Comedonal Acne Vulgaris That was Complicated by Staphylococcus Epidermidis and Pityrosporum Ovale Folliculities in 16th Years Old Atopic Hystory Girl that was Treated with 4x Tca 10% Chemical Peeling at 2 Weeks Intervals

Abstract

Lely Nurjanti

Acne vulgaris was very common self limitting disease, affected approximately 85% of adolesence, that was defined as a chronic inflammation of pilosebaceous units. It was characterized (diagnosed) by the formation of comedones (as primarily acne lession), erythemathous papules and pustules, less frequently nodules and pseudocyst, and was accompanied by scarring in some cases that caused psychosocial problems. Cunliffe classified the severity of acne vulgaris into 4 types based on the kind and number of acne lessions : mild, moderate, severe, very severe. Four major factors were involved in the etiopathogenesis: follicular hyperkeratinization, increased sebum production, abnormality of microbial flora and inflammation process. The goal of therapy were : removed plugging of the pilar drainage, reduced sebum production, treated bacterial colonization, prevented from scaring. The complications were acne scar, persistent hyperpigmentation, pyogenic granuloma formation, persistent swelling, gram negative bacteria folliculitis, bacterial and fungal folliculitis as secondary infection, resistances to antibiotics.

The purpose of this case report was to share experience in treating very severe comedonal acne vulgaris because of the chronicity course of acne vulgaris was difficult to be eradicated and there were many resistances problems to antibiotics in some literatures and journals.

Case Presentation: It was a very severe (4th grade) closed comedonal acne vulgaris that was complicated by Staphylococcus epidermidis and Pityrosporum ovale folliculitis in 16th years old atopic hystory girl based on anamnesis, clinical finding and laboratory examination. And this case was treated by 4x TCA 10% chemical peeling at 2 weeks intervals, 2 weeks antibiotic and 10 days ketokonazole after the result of culture and laboratory examination were positive. And the result was good. There was significant improvement in clinical stage (4th grade to 1st grade acne vulgaris), decreased the count of comedones, diminished papules-pustules and inflammation, no scar and post inflamatory hyperpigmentation were occured

Discussion: TCA 10% was superficial chemical peeling, considered as adjunctive therapy to the first line acne therapy retinoids and antibiotic, and TCA was the first line therapy for acne scar and skin rejuvenation. TCA was cheap and save because no systemic absorbtion, had keratolytic effect (comedolytic action) and anti inflammatory effect (bactericidal action). It could be combined to antibiotics and antifungal therapy and solved resistance problems to antibiotic and antifungal in acne therapy.

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