Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

12 Acne Acromegaly

■Laser/related modalities: limited by availability and cost restraints

at present

follow-up

■Allow 6–8 weeks for topical or oral antibiotic therapies to take effect

■Expect gradual improvement over months with these agents

■Add to or alter these regimens at 6–8 week intervals

■Once control is established, may need to see patient only every 6–12

months

■With oral retinoid use, patients should be seen monthly with appro-

priate laboratory studies to include: CBC, liver function panel, lipid

panel,+/−pregnancy test,+/−BUN and creatinine (Note: registra-

tion in the “iPLEDGE” program now mandatory for those prescrib-

ing, taking or dispensing Isotretinoin.)

■Standard course of Isotretinoin is 5 months, but may be repeated in

selected individuals

complications and prognosis

Complications

■Scarring: Occurs in nearly 100% of untreated cystic acne patients

➣Occurs in approximately 25–50% of papulopustular patients

(increased risk if lesions are excoriated or otherwise manipu-

lated)

■Keloid formation: 10–20% of cystic patient, especially prominent on

central chest and shoulders

■Psycho-social considerations

➣Depression or withdrawal occurs in a minority of patients

➣Does not necessarily correlate with severity of acne

➣Should be monitored for at each visit with early intervention, if

indicated

Prognosis

■Excellent with early, appropriate level of intervention

Acromegaly.........................................

ANDREW R. HOFFMAN, MD

history & physical

History

■Enlargement of hands and feet

■Prognathism and loose teeth

■Increased sweating