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Acne Vulgaris

This document provides an overview of acne vulgaris, including its definition, pathophysiology, clinical features, differential diagnosis, psychological effects, and management. It defines acne as a chronic inflammatory disease of hair follicles characterized by non-inflammatory and inflammatory lesions. The key factors in its pathogenesis are abnormal hair follicle proliferation, excess sebum production, Propionibacterium acnes bacteria, and inflammation. Clinical features include blackheads, whiteheads, papules, pustules, and nodules. Management involves general measures, topical and oral medications like retinoids, antibiotics, and isotretinoin, as well as hormonal therapy, laser treatment, and dermabrasion for scarring.

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27 views67 pages

Acne Vulgaris

This document provides an overview of acne vulgaris, including its definition, pathophysiology, clinical features, differential diagnosis, psychological effects, and management. It defines acne as a chronic inflammatory disease of hair follicles characterized by non-inflammatory and inflammatory lesions. The key factors in its pathogenesis are abnormal hair follicle proliferation, excess sebum production, Propionibacterium acnes bacteria, and inflammation. Clinical features include blackheads, whiteheads, papules, pustules, and nodules. Management involves general measures, topical and oral medications like retinoids, antibiotics, and isotretinoin, as well as hormonal therapy, laser treatment, and dermabrasion for scarring.

Uploaded by

SloOw JamZz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Acne Vulgaris

Prof.Dr. Tariq Rashid


Background
• Common skin disease affecting 85-100%
0f people at sometime during their lives
Definition
• Chronic inflammatory disease of
pilosebaceous follicle characterized by
non-inflammatory (comedones) & by
inflammatory lesions (red papules,
pustules, nodules) in its more severe form.
Affects areas of skin with dense population
of sebaceous glands (Face, upper chest,
back)
Clinical Features
• Age
– 12-35 years (commonly)
• Sites
– Face (90%), Back (60%), Chest (15%)
Pathophysiology
• Pathogenesis is multifactorial
• Four Key Factors
– Abnormal ductal hyperproliferation causing
excessive keratin formation ,obstructing duct
and producing comedones
– Excess sebum production
– Propionobacterium acnes bacterial
(presence & activity)
– Inflammation
Abnormal ductal hyperproliferation
• First recognized event
• Causes of hyperproliferation (Exact cause
not known)
– Androgen Hormones
– Changes in lipid composition
– Pro-inflammatory mediators (IL-1 especially)
Excessive Sebum production
• Different hormones & mediators regulate
sebum production & excretion (Androgens,
Growth Hormone, Insuline-like growth
factor)
• End-organ hyper-responsiveness to
hormones
P.Acnes
• Anaerobic organism
• Promotes inflammation through various
means
– Pro-inflammatory mediators(IL-2,IL-8,TNF)
– Hypersensitivity to P.Acne
Factors Influencing Acne
• Genetic
• Oily cosmetics, hair pomades
• Medicines
– Steroids, Lithium
– Antiepileptics
– Antituberculous
– Iodides
Factors Influencing acne
• Diet
– Scientific proof is lacking.
– Chocolate & diet restriction of no value
– No Definite link of acne severity with
calorie intake, carbohydrates, lipids &
protein intake.
Factors Influencing Acne
• Pre-menstrual Flare
– About 70% women complain of acne-
flare 2-7days premenstrually
– Due to increase hydration of the duct
– Pro-inflammatory effects of estrogens &
progesterons
Factors Influencing Acne
• Sweating
– About 15% complain of acne-flare with
increase sweating
– Probably related to ductal hydration
Factors Influencing Acne
• Occupation
– Catering
– Patients dealing with oil industry
Factors Influencing Acne
• Endocrine disorders
– Polycystic Ovary Syndrome
– Congenital adrenal hyperplasis
– Other endocrine disorders with excess
androgens
Factors Influencing Acne
• Occlusive Cosmetics/Hair
Pomades
• Halogenated Hydrocarbons
• Heat/Humidity
• Excessive/Vigorous Washing
• Friction/Pressure
• Manipulation of Lesions
Clinical Features
• Non-Inflammed Lesions
– Blackheads (Open Comedones)
– Whiteheads (Closed Comedones)
Microcomedone
Closed
Comedone
Open Comedone
Types of
Comedones
Clinical Signs
(Cmedonal Acne)
• Open (black) Comedones
– Sebum & Keratin accumulate
– Appear black papules
Closed (White) Comedones
• Appear as skin-coloured papules
• Sebum & keratin accumulate
• It lies at a distance from follicular opening
Clinical Features
• Inflammatory Lesions
Red papules
Pustules
Nodules
Clinical Features

• Healing Lesions
– Pigmented macules
– Scarring
Scars in Acne

 Hypertrophic
 Keloids
 Atrophic depressed
D/D
• Rosacea
• Bacterial Folliculitis
Psychological Effects of Acne
• Stress
• Embarrassment
• Anxiety
• Lack of confidence
• Impaired social contact
• Anger
• Suicidal ideation
MANAGEMENT
General Measures
• Avoid oil-based cosmetics
• Avoid manipulation of lesions
• Avoid topical Steroids
• Avoid Fairness creams
• Avoid Facials, Massage
Acne Myths
• Not to worry, “You will grow out
of it”
• Acne is caused by poor hygiene
• Acne is caused by something in
your diet
• Vigorous washing helps
• Treatments don’t work
Lab.Investigations
• Hormonal evaluation: (Serum
Testosterone, DHEA-S, Pelvic US) be
done in patients with dysmenorrhea &
hirsutism
Topical Therapy
• Retinoids
• Benzoyl Peroxide
• Antibiotics
Retinoids
• Retinoic Acid or Tretinoin
– Vitamin A analogue
• Mode of Action
– Effective against comedones, as it normalises
follicular keratinization
– Anti-inflammatory
Clinical Use
• Available in 0.05% concentration
• Use only at night as it can cause
photosensitivity
• Apply to all acne-prone areas
• Side Effects
– Irritation. dryness, redness, aggravation of
acne.
Other Retinoids
• Isotretinoin
• Adapalene
• Tazarotene
• ADVANTAGE
– Less irritating
Benzoyl Peroxide
• Mode of Action
– Antimicrobial
– Anti-inflammatory
• Clinical Use
– Available in 2.5%,4%,5% concentration
– Initially used in lower concentration for short
period(1-2 hours)
• Side Effects: irritation
Topical Antibiotics
• Clindamycin (1-2%),Erythromycin(2-4%)
• Mode of action
– Suppresses P.Acnes
– Anti-inflammatory
• Clinical Use:Usually used in combination
with retinoids & Benzoyl peroxide
• Side Effects: Resistance of P.Acnes
Other Topical Agents
• Azelaic Acid(20%)
• Salicylic Acid
• Sulpher
Systemic Treatment
• Antibiotics
– Tetracyclines,including Doxycycline &
Minocycline
– Erythromycin & Azithromycin
– Sulphamethoxazole-Trimethoprim
• Mode of Action
– Inhibit growth of P.Acnes
– Anti-inflammatory Effects
Clinical Use
• Moderate to severe acne and in patients
with psychological problems
• Tetracycline (01 g), Doxycycline (100 mg)
Minocycline (100 mg)
• Erythromycin (01 g), Azithromycin (500 mg
on alternate days)
• Daily for long periods of time (upto 06
months sometimes even longer)
Hormonal Therapy
• Antiandrogens
– Decrease sebum secretion rate
– Cyproterone acetate: available in
combination with ethinyl estradiol (02
mg cyproterone acetate,35 microgram
ethinylestradiol).Used in difficult to treat
acne in females
– Spironolactone: 50-100mg daily is
another alternative
Oral Isotretinoin
• It has revolutionized the management of
severe and intractable acne
• Mode of Action
– Inhibits sebum secretion
– Decreases P. Acnes count
– Reduces inflammation
Treatment Schedule
• Dose: 0.5-1 mg /kg body weight daily for a
period of 12-16 weeks
• Indications:
– Severe acne
– Moderate acne not responding to
conventional therapy
Side Effects
• Dry skin, cheilitis, dry eyes,
• Few may chow initial flare
• Teratogenicity
• Monitoring:
– Pregnancy test
– CBC, LFTs, Lipid Profile
Physical modalities
• Intralesional Steroids
• Cryotherapy
• Laser Therapy-Fractional Co2 and
ERG:GLASS resurfacing for acne scars
• Dermabrasion
• Injectable Fillers
Message
Acne, being so common a problem
every medical graduate should have
clear basic concept of acne so as to
manage patients effectively

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