Steroid acne after orthognathic surgery D. S. Precious, DDS, MSc, FRCD(C),a C. D. Hoflman. DDS, MSc, IWRCD(C),~ and R. Miller, MD, FRCP(C)’ Halifax, Canada DALHOUSIE
UNIVERSITY
Steroid acne is a common unwanted effect in patients undergoing corticosteroid therapy. Eight women in a series of 1276 adult patients had acne after orthognathic surgery in which short-course parenteral corticosteroid therapy was used to reduce postoperative swelling. Steroid-induced acneiform eruption is different from acne vulgaris in that the former usually resolves on its own, without scar formation, after withdrawal of the drug. (ORAL SURC ORAL MED ORAL PATHOL 1992;74:279-81)
S
teroid acne after organ transplantation and oncologic treatment is well known. In one study, steroid acne developed in 42% of heart transplant patients.’ There is a paucity of reports in the literature about acne as a complication of orthognathic surgery in spite of the fact that in North America, short-course corticosteroid therapy is almost universally used to control postoperative edema. Commonly used regimens involve total dosesof either 1830 mg of methylprednisolone or 40 mg of dexamethasone administered over about 30 hours. It was the purpose of this study to determine the incidence of steroid acne in 1276 adult patients who underwent orthognathic surgery. MATERIAL AND METHODS Patient sample
The medical records of all patients who met the following criteria were included in the study: (1) had undergone orthognathic surgery of any type in the maxilla, mandible, and/or chin between January 1985 and June 1989; (2) was treated with shortcourse parenteral corticosteroid therapy to control postoperative edema; and (3) had follow-up notations at 1 month and at least 6 months after surgery. Analysis
Patients were grouped according to sex, age, and the presenceor absenceof a postoperative complaint aProfessor, Department of Oral and Maxillofacial Surgery. bFormer Resident, Department of Oral and Maxillofacial Surgery. CAssistant Professor, Department of Medicine (Dermatology). 7/12/38816
of skin eruptions that were not present before surgery. Each patient who complained of a postsurgical skin problem was examined by a dermatologist who established the skin history and supervised the management of the problem. RESULTS
There were 1276 patients; 28% were men and 72% were women. Orthognathic surgery was performed most commonly on patients between 20 and 29 years of age (range, 15 to 72 years). Eight women, whose agesranged from 24 to 36 years and who had no previous history of acne, had postsurgical steroid-induced acne. In all casesthe acneiform skin eruptions slowly resolved without scarring, the only therapy was topical 5% benzyl peroxide. No male patients experienced this complication. DISCUSSION
Steroid acne is a not uncommon side effect seenin patients on corticosteroid therapy after organ transplantations and oncologic treatment regimens. Typically steroid acne occurs within 2 weeks of the start of systemic corticosteroid therapy and usually involutes and disappears without scarring once the medication is discontinued. Although adults are more commonly affected, there are reports of this condition among children and infants.2 The eruption is characterized by fresh-colored to pink-to-red, dome-shaped papules and papulopustules scattered on the face (Fig. l), upper part of the trunk, and upper extremities. There is usually an absence of comedones,and the papules are monomorphic in appearance in contrast to acne vulgaris, in 279
280
Precious, Hofman,
und Miller
ORAL SURG ORAL Mtu
ORAL. PAlHOI.
September 1992
Fig. 1. A, Skin condition of lower face of a 34-year-old woman 5 months before orthognathic surgery. B, Steroid acne developed 14 days after bilateral sagittal split osteotomy to advance the mandible. Short-course corticosteroids were used to diminish postsurgical edema. C, Skin condition 3 months after surgery. Treatment consisted of avoidance of all cosmetics and topical application of 5% benzyl peroxide.
whit ch one usually sees lesions in various stages of develo lpment from comedones to papules, pustules, and POSS ;ibly nodules and cysts. A Athough the precise pathogenesis of this condition
is still uncertain, the histologic development of infundibular spongiosis, hyperkeratosis, and micx0comedo formation and rupture appear crucial to the development of the papules and papulopustules.3
Volume 74 Number 3
Steroid acne after orthognathic surgery usually causesthe patient a great deal of concern, particularly when there is no history of past problems with acne. After a definitive diagnosis has been established, the patient must be reassuredof the fact that steroid acne is quite different from acnevulgaris in that the former usually resolves spontaneously and leaves no scars. Patients should be advised to wash with water only and to avoid the use of all cosmetics on the affected area until the skin is free of eruptions. Topical benzyl peroxide is generally helpful if needed.
Steroid acne after orthognathic
surgery
281
REFERENCES 1. Goldstein GD, Gollub S, Gill B. Cutaneous complications of heart transplantation. J Heart Transplant 1986;5:143-7. 2. Latif R, Laude TA. Steroid acne in a 14-month-old boy. Cutis 1982;29:373-6. 3. Hurwitz RM. Steroid acne. J Am Acad Dermatol 1986; 21:1179-81. Reprint requests:
David S. Precious, DDS, MSc, FRCD(C) Professor of Maxillofacial Surgery Dalhousie University Halifax, Nova Scotia, Canada. B3H 355
UNIVERSITY
Steroid acne is a common unwanted effect in patients undergoing corticosteroid therapy. Eight women in a series of 1276 adult patients had acne after orthognathic surgery in which short-course parenteral corticosteroid therapy was used to reduce postoperative swelling. Steroid-induced acneiform eruption is different from acne vulgaris in that the former usually resolves on its own, without scar formation, after withdrawal of the drug. (ORAL SURC ORAL MED ORAL PATHOL 1992;74:279-81)
S
teroid acne after organ transplantation and oncologic treatment is well known. In one study, steroid acne developed in 42% of heart transplant patients.’ There is a paucity of reports in the literature about acne as a complication of orthognathic surgery in spite of the fact that in North America, short-course corticosteroid therapy is almost universally used to control postoperative edema. Commonly used regimens involve total dosesof either 1830 mg of methylprednisolone or 40 mg of dexamethasone administered over about 30 hours. It was the purpose of this study to determine the incidence of steroid acne in 1276 adult patients who underwent orthognathic surgery. MATERIAL AND METHODS Patient sample
The medical records of all patients who met the following criteria were included in the study: (1) had undergone orthognathic surgery of any type in the maxilla, mandible, and/or chin between January 1985 and June 1989; (2) was treated with shortcourse parenteral corticosteroid therapy to control postoperative edema; and (3) had follow-up notations at 1 month and at least 6 months after surgery. Analysis
Patients were grouped according to sex, age, and the presenceor absenceof a postoperative complaint aProfessor, Department of Oral and Maxillofacial Surgery. bFormer Resident, Department of Oral and Maxillofacial Surgery. CAssistant Professor, Department of Medicine (Dermatology). 7/12/38816
of skin eruptions that were not present before surgery. Each patient who complained of a postsurgical skin problem was examined by a dermatologist who established the skin history and supervised the management of the problem. RESULTS
There were 1276 patients; 28% were men and 72% were women. Orthognathic surgery was performed most commonly on patients between 20 and 29 years of age (range, 15 to 72 years). Eight women, whose agesranged from 24 to 36 years and who had no previous history of acne, had postsurgical steroid-induced acne. In all casesthe acneiform skin eruptions slowly resolved without scarring, the only therapy was topical 5% benzyl peroxide. No male patients experienced this complication. DISCUSSION
Steroid acne is a not uncommon side effect seenin patients on corticosteroid therapy after organ transplantations and oncologic treatment regimens. Typically steroid acne occurs within 2 weeks of the start of systemic corticosteroid therapy and usually involutes and disappears without scarring once the medication is discontinued. Although adults are more commonly affected, there are reports of this condition among children and infants.2 The eruption is characterized by fresh-colored to pink-to-red, dome-shaped papules and papulopustules scattered on the face (Fig. l), upper part of the trunk, and upper extremities. There is usually an absence of comedones,and the papules are monomorphic in appearance in contrast to acne vulgaris, in 279
280
Precious, Hofman,
und Miller
ORAL SURG ORAL Mtu
ORAL. PAlHOI.
September 1992
Fig. 1. A, Skin condition of lower face of a 34-year-old woman 5 months before orthognathic surgery. B, Steroid acne developed 14 days after bilateral sagittal split osteotomy to advance the mandible. Short-course corticosteroids were used to diminish postsurgical edema. C, Skin condition 3 months after surgery. Treatment consisted of avoidance of all cosmetics and topical application of 5% benzyl peroxide.
whit ch one usually sees lesions in various stages of develo lpment from comedones to papules, pustules, and POSS ;ibly nodules and cysts. A Athough the precise pathogenesis of this condition
is still uncertain, the histologic development of infundibular spongiosis, hyperkeratosis, and micx0comedo formation and rupture appear crucial to the development of the papules and papulopustules.3
Volume 74 Number 3
Steroid acne after orthognathic surgery usually causesthe patient a great deal of concern, particularly when there is no history of past problems with acne. After a definitive diagnosis has been established, the patient must be reassuredof the fact that steroid acne is quite different from acnevulgaris in that the former usually resolves spontaneously and leaves no scars. Patients should be advised to wash with water only and to avoid the use of all cosmetics on the affected area until the skin is free of eruptions. Topical benzyl peroxide is generally helpful if needed.
Steroid acne after orthognathic
surgery
281
REFERENCES 1. Goldstein GD, Gollub S, Gill B. Cutaneous complications of heart transplantation. J Heart Transplant 1986;5:143-7. 2. Latif R, Laude TA. Steroid acne in a 14-month-old boy. Cutis 1982;29:373-6. 3. Hurwitz RM. Steroid acne. J Am Acad Dermatol 1986; 21:1179-81. Reprint requests:
David S. Precious, DDS, MSc, FRCD(C) Professor of Maxillofacial Surgery Dalhousie University Halifax, Nova Scotia, Canada. B3H 355
