Scribd Logo
Upload

Welcome to Scribd!

  • 35 views

    8 Acne Vulgaris and Rosacea

    Uploaded by

    Charl Unal
    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit commonly seen in adolescence caused by obstruction of hair follicles and inflammation from bacteria. It presents with non-inflammatory and inflammatory lesions on the face and body. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin depending on the severity to reduce inflammation, bacteria, and excess oil in the skin.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    8 Acne Vulgaris and Rosacea

    Uploaded by

    Charl Unal
    35 views35 pages
    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit commonly seen in adolescence caused by obstruction of hair follicles and inflammation from bacteria. It presents with non-inflammatory and inflammatory lesions on the face and body. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin depending on the severity to reduce inflammation, bacteria, and excess oil in the skin.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit commonly seen in adolescence caused by obstruction of hair follicles and inflammation from bacteria. It presents with non-inflammatory and inflammatory lesions on the face and body. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin depending on the severity to reduce inflammation, bacteria, and excess oil in the skin.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    35 views35 pages

    8 Acne Vulgaris and Rosacea

    Uploaded by

    Charl Unal
    Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit commonly seen in adolescence caused by obstruction of hair follicles and inflammation from bacteria. It presents with non-inflammatory and inflammatory lesions on the face and body. Treatment involves topical and oral antibiotics, retinoids, and isotretinoin depending on the severity to reduce inflammation, bacteria, and excess oil in the skin.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 35

    Acne vulgaris

    Dr. Deren Özcan


    Acne

    Chronic inflammatory
    disease of
    pilosebaceous unit
    Epidemiology
    Adolescence period (15-18 y)

    12-24 y 85%

    < 25 y spontaneous recovery

    Continue until 3. decade (especially female)

    12% F- 3% M 44 y

    Onset 20-35 y, neonatal-infantile period


    Pathogenesis
    Pathogenesis (2)

    Obstruction and dilatation of follicular lümen with


    keratin and sebum
    Inflammatory response
    Pathogenesis (3)

    Follicular hyperkeratinization
    Androgens
    Corneocytes cannot be shed out
    (Testosterone, DHT)
    Increase in sebum production

    Genetic predisposition
    Propionibacterium acnes
    Emotional stress
    Triggering factors
    Adolescence period

    Genetic factors

    Emotional stress

    Occlusion and pressure effect

    Drugs-------acneiform eruptions

    XXY genotype, endocrinologic diseases

    (PCOS, hyperandrogenism, hypercortisolism, puberte precox)


    Clinical findings
    Slow onset and progression

    Localization

    Face (most common)

    Trunk (Back, chest, shoulders)

    Lesions of different types

    Non-inflammatory (closed-open comedone) (primary)


    Inflammatory (erythematous papule, pustule, nodule, cyst)
    (secondary)
    Closed-open comedone
    Erythematous papule, pustule
    Nodule-cyst
    Types of acne
    Comedonal acne

    Papulopustular acne

    Nodulocystic acne-acne conglobata

    Acne fulminans Premenstrual acne


    Neonatal-infantile acne Tropical acne
    Acne cosmetica Radiation acne
    Acne excoriee Acne mechanica
    Comedonal acne

    Mildest type

    Comedones

    Face

    Scar
    Papulopustular acne

    Papule

    Pustule

    Comedone

    Scar
    Nodulocystic acne-Acne conglobata
    AC: most severe form
    More common in male ( 16 y)
    Face, shoulder, back, chest,
    gluteal region
    Multiple and binary-triple
    comedones
    Cyst, nodule, abcess
    Draining and coalescing sinuses
    Supuration
    Scar +
    Acne conglobata
    Neonatal-infantile acne
    Neonatal Acne:
    - First 2 weeks after birth
    - Regress within 3 months
    - 20% of healthy newborns
    - Cheeks and nose
    - Comedone
    - M. furfur?
    Infantile Acne:
    - 3-6. months - Immature adrenal gland (DHEA ),
    - Comedone + LH , maternal hormones
    - Regress at 1-2 years of age (childhood and adolescence period)
    Drug induced acne
    (Drugs that lead to acneiform lesions)

    - Monomorphic lesions
    Systemic glucocorticoids
    Fenytoin
    Lithium
    Anabolic steroids (danazol and testosterone)
    İsoniazid
    High dose vitB complex
    Cyclosporine
    İodides and bromides
    Erlotinib
    Steroid
    Other types of acne
    Acne cosmetica

    Acne excoriee

    Premenstrual acne

    Acne mechanica

    Tropical acne

    Radiation acne
    Diagnosis-differential diagnosis
    Clinical signs

    Laboratory

    (If hyperandrogenism, PCOS are suspected)

    Diff dx: Rosacea, folliculitis (erythematous papules

    and pustules, comedone )


    Rosacea
    Epidemiology

    30-50 year of age

    Female male

    More severe in men (phymatous changes)


    Pathogenesis
    Multifactorial

    Genetic predisposition

    Abnormal vasomotor response to thermal and other stimuli

    (vascular hyperreactivity)

    Chronic vasodilatation edema impaired lymphatic drainage

    telangiectasia, fibrosis

    Demodex folliculorum (mite which reşide in lümen of


    sebaceous follicle, triggering factor?)
    Triggering factors
    Hot foods, drinks
    Spicy foods
    Alcohol
    Ultraviolet radiation
    Hot environment, bath etc.
    Emotional stress
    Exercise
    Cold weather
    Erythematotelangiectatic Type

    Vaskular rosacea

    Flushing (episodic erythema)

    Persistant central fascial erythema

    Telangiectasia (ala nasi, nose,

    malar areas)

    Burning, stinging
    Papulopustular Type

    Persistant central fascial erythema

    Central fascial papules and/or pustules

    Comedone

    Flushing

    Burning, stinging: not prominent


    Glandular Type (Phymatous)

    Sebaceous gland hypertrophy (rhinophyma)

    Edematous papules, pustules,

    nodulocystic lesions

    Flushing is mild and telangiectasia are few

    Persistant edema
    - Granulamatous rosacea - Ocular rosacea
    Blepharitis, chalazion, conjunctivitis, keratitis, episcleritis

    - Steroid Rosacea (Topical steroid use)


    Scar
    Treatment
    Severity
    Age
    Scar
    Prior treatments
    Cosmetic products, sunscreen use history
    Topical treatment
    Systemic treatment
    Topical Treatment
    Topical retinoids
    - Comedolytic (follicular keratinization), anti-inflammatory,
    antiseborrheic
    - Night, all face, contraindicated in pregnancy
    - Local irritation, erythema, xerosis, sclaes, photosensitization
    - Acnelyse , tretin
    Benzoyl peroxide
    - Anti-bacterial (P.acnes), comedolytic
    - Stain clothes, irritation, Allergic contact dermatitis
    - Night, all face
    Topical Treatment (2)
    Topical antibiotics
    - Papulopustular lesions
    - Cannot be combined, resistance risk
    - Clindamycin (Cleocin-T lotion )
    - Erythromycin (Aknilox )
    - Tetracycline (İmex )
    Salicilic acid, azelaic acid
    Combination (eritretin , clindoxyl , benzamycin )
    Systemic Treatment
    Antibiotics
    1. Tetracyclines and derivatives
    a. Tetracycline
    - 2x500 mg/day ( dose according to clinical response) (3-6 months)
    - Clinical response at 4-6th week
    - Candidal vaginitis, GI side effects
    - Contraindicated in pregnancy and patients 10 y (Discoloration of
    teeth)
    - Contraindicated in renal failure
    - İnteraction with Ca, Fe prep. and antiacid drugs ( absorption)
    b. Minocycline
    c. Doxicycline (1 x 100 mg/day, photosensitivity)
    Systemic Treatment (2)
    Antibiotics
    2. Erythromycin
    - Pregnancy / when tetra is contraindicated
    - Efficacy , GI side effects
    3. Clindamycin
    4. Sulfanomides (TMP-SMX)
    5. Azithromycin
    Hormonal treatment
    - Hyperandrogenism, PCOS
    - Oral contraceptives, spironolactone
    Systemic Treatment (3)
    Isotretinoin (Roaccutane )
    - Severe acne, treatment resistant acne, scar
    - sebum production, correct f. keratinization, antibacterial
    - 0.5-1 mg/kg/day, 120-150 mg/kg total cumulative dose
    - Recurrence risk is low
    - Teratogenic (Pregnancy after 1-2 months of drug cessation)
    - Xerosis (lip, tears, oral-nasal mucosa, skin)
    - Lipids , LFT
    - Arthralgia, photosensitivity, psychological effect
    - Side effects are dose dependent

    You might also like