Scribd Logo
Upload

Welcome to Scribd!

  • 3 views

    ACNE

    Uploaded by

    bazil.musharraf97

    Copyright:

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

    ACNE

    Uploaded by

    bazil.musharraf97
    3 views20 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    3 views20 pages

    ACNE

    Uploaded by

    bazil.musharraf97

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    ACNE

    VULGARIS
    INTRODUCTION

    • Most common cutaneous disorder affecting adolescents (10-


    19yrs) and young adults(10-24)
    • Estimates of the prevalence of acne vulgaris in adolescents
    range from 35 to over 90 percent
    • Postadolescent acne predominantly affects women, in contrast
    to adolescent acne, which has a male predominance
    • Acne vulgaris is a common inflammatory
    disorder of the pilosebaceous unit
    • Four main pathogenetic factors are involved:
    ●Follicular hyperkeratinization
    PATHOGEN ●Increased sebum production
    ESIS ●Propionibacterium acnes (also known
    as Cutibacterium acnes) within the follicle
    ●Inflammation
    • A microcomedo is considered the precursor for
    the clinical lesions of acne vulgaris
    • Accumulation of sebum and keratinous material
    converts a microcomedo into a closed comedo
    (a whitehead) The follicular orifice is opened
    with continued distension, forming an open
    comedone (a blackhead) Densely packed
    TYPES keratinocytes, oxidized lipids, and melanin all
    contribute to the dark color of the open
    comedo.
    • Follicular rupture contributes to the
    development of inflammatory lesions. Following
    follicular rupture, proinflammatory lipids and
    keratin are extruded into the surrounding
    dermis, leading to inflammatory papule or
    nodule formation
    CLINICAL PRESENTATION

    • Affects those areas of the body that have the largest, hormonally-
    responsive sebaceous glands; face, neck, chest, upper back, upper arms
    • Adult women may present with acne involving the lower face and neck that
    is often associated with premenstrual flares, more common in women over
    the age of 33 than in women aged 20 to 33 years
    • Mild acne – open and closed comedones (blackheads and whiteheads)
    noninflammatory lesions involving the forehead, nose and chin
    • Moderate and severe acne – papules, pustules, nodules and cyst
    FACTORS THAT CAUSE ACNE

    • Androgen levels
    • Insulin resistance
    • External factors ( soaps, detergents, mechanical )
    • Diet
    • Family history
    • Stress
    • Medicines
    ACNE VARIANTS

    • Patients with acne vulgaris may exhibit variants of the disease


    • Acne fulminans is a disorder characterized by an acute eruption of large,
    inflammatory nodules and friable plaques with erosions, ulcers, and hemorrhagic
    crusts
    - triggered by isotretinoin therapy or may occur spontaneously
    - occur in association with systemic symptoms (eg, fever, malaise, bone pain,
    arthralgias), erythema nodosum, and laboratory and radiologic abnormalities
    (leukocytosis, anemia, and an elevated C-reactive protein)
    • Acne conglobata is a severe form of nodular acne that is most commonly seen in
    young males. Lesions are most prominent on the back, chest, and buttocks, but can also
    appear in other sites. Large draining lesions, sinus tracts, and severe scarring
    may occur. Systemic symptoms are absent.
    DIAGNOSTIC EVALUATION

    • Hyperandrogenism
    -In women, polycystic ovary syndrome (PCOS) is the most common cause of
    hyperandrogenism characterized by menstrual irregularity, hirsutism, acne,
    ovarian cysts, and varying degrees of insulin resistance
    • Medications:
    - glucocorticoids, phenytoin, lithium, isoniazid, epidermal growth factor
    inhibitors, iodides, bromides, androgens, and other drugs
    • Physical examination and History
    TOPICAL TREATMENT

    • Topical retinoids like retinoic acid, adapalene, and tretinoin are used alone
    or with other topical antibiotics or benzoyl peroxide. Retinoic acid is the
    best comedolytic agent, available as 0.025%, 0.05%, 0.1% cream, and gel.
    • Topical clindamycin 1% to 2%, nadifloxacin 1%, and azithromycin 1% gel
    and lotion are available. Estrogen is used for Grade 2 to Grade 4 acne.
    • Topical benzoyl peroxide is now available in combination with adapalene,
    which serves as comedolytic as well as antibiotic preparation. It is used as
    2.5%, 4%,and 5% concentration in gel base.
    TOPICAL CONTINUED

    • Azelaic acid is antimicrobial and comedolytic available 15% or 20% gel. It


    can also be used in postinflammatory pigmentation of acne.
    • Beta hydroxy acids like salicylic acid are used as topical gel 2% or
    chemical peel from 10% to 20% for seborrhoea and comedonal acne, as
    well as, pigmentation after healing of acne.
    • Topical dapsone is used for both comedonal and papular acne, though
    there are some concerns with G6PD deficient individuals.
    SYSTEMIC TREATMENT

    • Doxycycline 100 mg twice a day as an antibiotic and anti-inflammatory


    drug as it affects free fatty acids secretion and thus controls inflammation.
    • Minocycline 50 mg and 100 mg capsules are used as once a day dose.
    • Other antibiotics such as amoxicillin, erythromycin, and
    trimethoprim/sulfamethoxazole are sometimes used, and if bacterial
    overgrowth or infection is masquerading as acne, other antibiotics such as
    ciprofloxacin may be used in pseudomonas related 'acne.'
    SYSTEMIC CONTINUED

    • Isotretinoin is used as 0.5 mg/kg to 1 mg/kg body weight in daily or weekly pulse
    regimen. It controls sebum production, regulates pilosebaceous
    epidermal hyperproliferation, and reduces inflammation by controlling P. acnes. It may
    give rise to dryness, hairless, and cheilitis.
    • An oral contraceptive containing low dose estrogen 20 mcg along with cyproterone
    acetate as anti-androgens are used for severe recurrent acne.
    • Spironolactone (25 mg per day) can also be used in males. It decreases the production
    of androgens and blocks the actions of testosterone. If given to females, then pregnancy
    should be avoided because the drug can cause feminization of the fetus.
    • Scars are treated with submission, trichloroacetic acid, derma roller, microneedling, or
    fractional CO2 laser.
    COMPLICATIONS

    • Post inflammatory hyperpigmentation


    • Scarring
    • Deformity
    • Psychological and social effects
    QUIZ
    REFERENCES

    • Purdy, S., & de Berker, D. (2011). Acne vulgaris. BMJ clinical evidence, 2011,
    1714.
    • Sutaria AH, Schlessinger J. Acne Vulgaris. [Updated 2019 Oct 25]. In:
    StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019
    Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459173/

    You might also like