Phenobarbitone and troxidone are said to be provoking factors in a severe acne sometimes  seen  in  epileptic patients. The precise mechanism of this is uncertain but it is probably  drug induced. In 1972 Walshe studied 500 patients at the Chalfont Centre  for Epilepsy and found that 35  per  cent of them had  acne.42 The acne persisted to a  later age than in  the normal population and 11 per cent of the men aged 51-60  still had acne. Phenobarbitone is used much  less frequently in the treatment of epilepsy  and  troxidone is not used at all. Burton  is of the impression that severe acne is  now much less common in epileptic  patients than it used to be.

The investigation of severe epileptics who were institutionalized found that, despite their need for many and high-dose anti-epileptic  therapies, they  did not suffer from significant acne and had a  low sebum excretion.44 This may be related to a lower than normal circulating level of sex hormones. Severe epileptics are known to have many  endocrine problems,  in  particular, a low testosterone secretion. There is a complex link between epilepsy and acne which depends upon  the endocrine background of the  individual and the changing pattern of epileptic therapies. their research of the literature, lithium can cause, or exacerbate, acneiform eruptions which may prove more persistent and troublesome to treat. In the ninety-one lithium-treated subjects  in their  study,  there  were twenty-one cases of acne whereas there were only six cases among the forty-four comparison subjects.

Ten cases in the lithium-treated subjects and two cases in the comparison subjects were either new cases or relapses, and may have been secondary to medication. Cyclosporin In a study by Bencini et al, sixty-seven kidney transplants treated with cyclosporin and methylprednisolone were evaluated for the presence of dermatological manifestations.51 Only two patients  had no dermatological lesions, while 80 per cent had iatrogenic lesions, 38 per cent infectious  lesions, 13  per  cent miscellaneous lesions, 3 per cent cancerous lesions and 28 per cent skin conditions related to their previous uraemic state. Involvement of the pilosebaceous unit was seen in most patients:  hypertrichosis (60 per cent), epidermal cysts (28 per cent), pilar keratosis (21 per cent), acne (15 per cent), folliculitis (12 per cent) and sebaceous hyperplasia (10 per cent).