Itching in acne--an unusual complication of therapy.
Pruritus at the site of active acne has not been described before as a complication of acne therapy. We report 8 cases seen over a 3-year period at our department with localized itching mainly at the active acne sites, within 2-6 weeks of starting effective acne therapy. Seven had oral tetracyclines (oxytetracycline, Vibramycin or Minocin) with or without topical antibiotics or benzoyl peroxide. Only 1 patient received oral isotretinoin. The severity of itch was mild to moderate in most cases with the severest reaction in the isotretinoin-treated patient. All cases resolved within 4 weeks, 7 with non-sedative antihistamine therapy (terfenadine), and 1 resolved spontaneously upon cessation of antibiotic therapy. The pathogenesis of this localized itch is presumed to be related to the change in pH of the micro-environment of the acne follicle providing an optimal environment for the production of histamine or histamine-like products by Propionibacterium acnes. This report highlights the self-limiting nature of pruritus during effective anti-acne therapy. Increased awareness of this uncommon complication helps prevent the unnecessary discontinuation of effective acne therapy.
Yee
K C
KC
Dermatology Department, General Infirmary, Leeds, UK.
Cunliffe
W J
WJ
D000152:Acne Vulgaris / Q000188:drug therapy*; D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011537:Pruritus / Q000139:chemically induced* / Q000188:drug therapy; D012720:Severity of Illness Index; D016593:Terfenadine / Q000627:therapeutic use; D013997:Time Factors
D000900:Anti-Bacterial Agents; D016593:Terfenadine; D015474:Isotretinoin