Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    Acne

    Uploaded by

    Hitesh N Rohit
    Acne is a common skin condition affecting more than 80% of people at some point in their life. It is caused by increased sebum production, hypercornification of pilosebaceous ducts, and inflammation induced by colonization of Propionibacterium acnes bacteria. Treatment involves topical and oral antibiotics, retinoids, and hormonal therapy. For severe nodular cystic acne, isotretinoin may be used, though it can have teratogenic and other side effects requiring monitoring. Management requires assessment, patient education, and choosing appropriate therapies based on acne severity.

    Copyright:

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

    Acne

    Uploaded by

    Hitesh N Rohit
    9 views44 pages
    Acne is a common skin condition affecting more than 80% of people at some point in their life. It is caused by increased sebum production, hypercornification of pilosebaceous ducts, and inflammation induced by colonization of Propionibacterium acnes bacteria. Treatment involves topical and oral antibiotics, retinoids, and hormonal therapy. For severe nodular cystic acne, isotretinoin may be used, though it can have teratogenic and other side effects requiring monitoring. Management requires assessment, patient education, and choosing appropriate therapies based on acne severity.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Acne is a common skin condition affecting more than 80% of people at some point in their life. It is caused by increased sebum production, hypercornification of pilosebaceous ducts, and inflammation induced by colonization of Propionibacterium acnes bacteria. Treatment involves topical and oral antibiotics, retinoids, and hormonal therapy. For severe nodular cystic acne, isotretinoin may be used, though it can have teratogenic and other side effects requiring monitoring. Management requires assessment, patient education, and choosing appropriate therapies based on acne severity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    9 views44 pages

    Acne

    Uploaded by

    Hitesh N Rohit
    Acne is a common skin condition affecting more than 80% of people at some point in their life. It is caused by increased sebum production, hypercornification of pilosebaceous ducts, and inflammation induced by colonization of Propionibacterium acnes bacteria. Treatment involves topical and oral antibiotics, retinoids, and hormonal therapy. For severe nodular cystic acne, isotretinoin may be used, though it can have teratogenic and other side effects requiring monitoring. Management requires assessment, patient education, and choosing appropriate therapies based on acne severity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 44

    ACNE

    Dr. Pankil patel


    Introduction

     One of the commonest skin conditions seen

     Easily diagnosed

     May affect mental and social well being

     Affects more than 80% people at some point in

    their life
    Acne vulgaris

    Definition:

    Acne is a chronic inflammatory disease of the

    pilosebaceous units, characterized by

    seborrhoea, formation of comedones,

    erythematous papules, pustules & less

    frequently by nodules, cysts and scarring.


    Epidemiology
     Typically occurs around adolescence
     Can present in neonate, can persist beyond
    adolescence in susceptible individuals
     Physiological acne considered a normal variant
    of maturation
     Clinicalacne persists and progresses beyond
    the period of adolescence
     30% of teenagers have acne of sufficient
    severity to require some form of treatment
    Pathogenesis of acne
     Increased sebum production
     Hypercornification of the pilosebaceous duct
     Colonisation of the duct with Propionibacterium
    acnes
     Inflammation
    Seborrhoea
     Increased androgenic sex hormones of gonadal
    / adrenal origin(especially in women with
    polycystic ovarian disease)
     Abnormalend-organ response to normal level
    of hormones
     Abnormal composition of sebum
     Lowerlevels of linoleic acid → ductal
    hypercornification
    Comedogenesis
     Abnormalities in proliferation and differentiation
    of ductal keratinocytes
     Retentionof hyperproliferating ductal
    keratinocytes
     Increased cohesiveness of ductal keratinocytes
    These lead to formation of the microcomedone
    which is the precursor of all acne lesions
    Propionibacterium acnes
     Resident anaerobe which colonises the
    pilosebaceous duct in the presence of
    seborrhoea
     Hydrolyses the triglycerides in sebum to produce
    free fatty acids
     Produces mediators of inflammation
     The cell wall of P.acnes is a potent
    chemoattractant
    Inflammation
     Cytokinesproduced by sebum and ductal
    keratinocytes
     P.acnes& free fatty acids also contibute to the
    inflammation
     Cytokines attract neutrophils and mononuclear
    cells
     In moderate and severe cases there is rupture of
    the duct and a macrophage giant cell foreign
    body reaction
    Pathogenesis
    Grades of Acne (Pillsburry’s classification)
     Grade I: comedones (open or closed), occ.
    papules
     Grade II: papules, comedones, few pustules
     Grade III: predominant pustules, nodules,
    abscesses
     Grade IV: mainly cysts, abscesses, scars
    Grade I
    Grade II
    Grade III
    Grade IV
    Grade IV
    Co-factors
    Aggravating Relieving
     Premenstrual  UV radiation?
     UV radiation?
     Stress
     Sweating
     Smoking
    Scarring
     Consequence of abnormal resolution or wound
    healing following the inflammation
     Ice-pick
    scars are seen in most patients with
    grades I and II acne while depressed or
    hypertrophic scars are seen in nodulocystic acne
    Hyperpigmentation
     In patients
    paticularly with type
    III/IV skin,
    hyperpigmented
    macules may persist
    following the
    resolution of
    inflammatory acne
    lesions
    Uncommon Variants of Acne
     Drug induced acne/ acneiform eruption
     Acne excoriee
     Acne conglobata
     Acne fulminans
     Acne mechanica
     Occupational acne/chloracne
     Pyoderma faciale
     Late onset acne/endocrine acne
     Cosmetic/pomade acne
     Tropical acne
     Gram negative folliculitis
    Drug induced acne
     Papules and pustules , comedones usually
    absent
     Drugs implicated:
    ◦ Halogens
    ◦ Androgens
    ◦ Steroids
    ◦ INH,Rifampcin
    ◦ Lithium
    ◦ Phenytoin
    ◦ PUVA
    P. folliculitis
    Rosecea
    Chloracne
    Acne excoriee
    Acne
    conglobata
    Psychosocial aspects
     Stress induces acne
     Increased anger and anxiety
     Social embarrassment
     Lack of self confidence
     Depression
     Dysmorphophobia
    Differential diagnosis
     Rosacea
     Pityrosporum folliculitis
     Pseudo folliculitis
     Milia
     Plane warts
     Tuberous sclerosis

     Acne scarring may be mistaken for acne


    keloidalis, varioliform, atrophy and porphyria
    cutanea tarda.
    Guidelines of treatment
     Acne assessment (of severity)
     Patient education
     Discussion of goals of treatment and patient
    expectations
     Choice of therapy
    Guidelines of treatment
     Topical antibiotics - erythomycin, clindamycin,
    tetracycline, clarithromycin, doxycycline
     Benzoyl peroxide
     Azelaic acid
     Topical retinoids - retinoic acid, adapalene,
    tazarotene
    Oral therapy
     Antibiotics:
    Erythromycin
    Azithromycin (pulse dosing)
    Tetracycline
    Doxycycline
    Minocycline
    Trimethoprim
    Dapsone
    Side effects of oral antibiotics
     Doxycycline - onycholysis, oesophagitis with
    ulceration, fixed drug eruptions, photosensitivity
    etc.
     Minocycline - benign intracranial hypertension,
    pappiloedema, blue-black pigmentation and
    rarely hypersensitivity reactions
     Macrolide group - gastritis, diarrhoea
     Co-trimoxazole - severe drug reactions
     Dapsone - hemolytic anemia, dapsone
    syndrome etc.
    Hormonal therapy
     Antiandrogens – cyproterone acetate(50-100
    mg/day)
     Oral contraceptives - 35 mcgs ethinyl estradiol
    plus 2 mgs cyproterone acetate
     Levonorgestrel+ethinyl estradio (100+20 mcgs)
     Other regimens - prednisolone plus oestrogen,
    spironolactone and antiandrogens
     Drosperinone – novel progestin derived from
    spironolactone
     Oral contraceptives containing androgenic
    progesterones such as norethisterone must be
    avoided.
    Side effects of Hormonal therapy
     Weight gain
     Menstrual irregularity
     Occasional fluid retention
     Melasma
     Hypertension
     Thrombophlebitis
     Pulmonary embolism
    Isotretinoin
    13-cis- retinoic acid (Vitamin A derivative )
     Mechanism of action:
    ◦ Decreases the size of sebaceous glands
    ◦ 80% reduction in sebum
    ◦ Alters the composition of sebum
    ◦ Reduces comedogenesis
    ◦ Lowers P.acnes concentration and has anti-
    inflammatory activity
    Isotretinoin
     Indicated for :
    ◦ Nodulocystic/ severe Acne
    ◦ Pyoderma faciale
    ◦ Acne recalcitrant to routine treatment
    ◦ Excessive seborrhoea
    ◦ Depression / Dysmorphophobia
    ◦ Acne conglobata / other unusual variants
    ◦ Scarring
    Isotretinoin
     Dose: 0.5 – 1 mg/ kg per day is given after
    meals. Cumulative dose: 120-150 mgs/kg
     Side effects
    ◦ Teratogenicity
    ◦ Mucocutaneous side effects, dryness
    ◦ Elevation of serum lipids
    ◦ Neurological : pseudotumor cerebri, optic
    Neuritis, depression, mood swing
    ◦ Arthritis, myalgia
    ◦ Acne flares
    Physical modalities
     Comedo expression
     Aspiration of cystic lesions
     Intralesional steriods
     Cryotherapy
    Newer options
     Photodynamic therapy using blue red light
     Low fluence pulsed dye laser light
     Dermabrasion / CO2 laserbrasion (ice-pick scars)
     Erbium-YAG laser for atrophic /hypertrophic scars
     Punch grafting / punch floats (for depressed
    scars)
    Acne treatment plan
     Topical therapy for grade I & grade II acne
     Oral antibiotics in moderate to severe acne
     Combination with topical retinoids improves
    efficacy and with benzoyl peroxide decreases
    resistance
     Duration 4-6 months
     Any treatment started must be continued for
    atleast 6 weeks before changing
     Advise on potential side effects
     Systemic isotretinion is indicated in severe
    nodulocystic acne, acne conglobata and acne
    recalcitrant to routine therapy
    Contd..
    Acne treatment plan
     Hormonal therapy is used for patients with
    moderate acne who also need contraception, or
    those who need hormonal therapy to regulate
    hormonal irregularities
     Encourage compliance
    Thank you

    You might also like