Physical Therapies in Acne Vulgaris

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role of isotretinoin and physical therapies used in acne

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Presentation Transcript

ROLE OF ISOTRETINOIN AND PHYSICAL THERAPIES IN ACNE VULGARIS : 

ROLE OF ISOTRETINOIN AND PHYSICAL THERAPIES IN ACNE VULGARIS By: Dr. Deepak Kumar

ISOTRETINOIN : 

Isotretinoin Vitamin A derivative Binds to RAR receptor Effects Reduces sebum production Comedogenesis Colonization of P.acnes Anti-inflammatory ISOTRETINOIN

ISOTRETINOIN : 

Indication Severe nodular acne Acne resistant to conventional treatments Persisted beyond the age of 25 years ISOTRETINOIN

ISOTRETINOIN : 

Usual dose 0.5–1.0 mg/kg /day For 16–30 weeks Total of 120 mg/kg Low-dose courses Adults with persistent acne Late-onset acne 0.5 mg/kg/day taken 1 week out of 4 For 6 months ISOTRETINOIN

ISOTRETINOIN : 

INITIATION AND MONITORING Females with childbearing potential Negative pregnancy test Initiat on third day Normal menstrual period Contraception During treatment 1 month before/after ISOTRETINOIN

ISOTRETINOIN : 

SIDE EFFECTS Teratogenic Spontaneous abortion Cardiovascular ASD VSD Mood changes Depression Excessive anger Liver function tests Transaminase ?× 3 Lipid profile Triglyceride ? 800 mg/dL ISOTRETINOIN Discontinue isotretinoin

ISOTRETINOIN : 

ISOTRETINOIN

PHYSICAL THERAPIES : 

PHYSICAL THERAPIES

ELECTROCAUTERY : 

Electrical current passes through tissue Heat produced Tissue destruction Indication Macrocomedones ELECTROCAUTERY

ELECTROCAUTERY : 

Method Local anesthetic EMLA For 60–75 min Cautery at low setting Complication Very little scarring Post-inflammatory pigmentation ELECTROCAUTERY

PHOTOTHERAPY : 

Natural sunlight Broad-spectrum sunlamp Blue light PHOTOTHERAPY

PHOTOTHERAPY : 

DESTRUCTION OF P.ACNES P.acnes Synthesizes intracellular porphyrins Absorbs light Singlet oxygen Attacks cell membrane PHOTOTHERAPY

PHOTOTHERAPY : 

BLUE LIGHT THERAPY(415 NM) Two 15 min sessions per week For 4 weeks Follow-ups 1- and 3-month Inflammatory acne 80% patients responded 60% reduction in lesions PHOTOTHERAPY

PHOTOTHERAPY : 

PHOTOTHERAPY Before blue light After

PHOTODYNAMIC THERAPY : 

Photosensitizer Light source Molecular oxygen PHOTODYNAMIC THERAPY

PHOTODYNAMIC THERAPY : 

Amino laevulinic acid (ALA) Absorbed by Pilosebaceous glands Actinically damaged skin Skin cancer cells Absorbs light in the 415- to 630-nm range Damage the sebaceous glands Sebum suppression Decrease in P. acnes PHOTODYNAMIC THERAPY

PHOTODYNAMIC THERAPY : 

Technique Wash the face Apply ALA Wait Wash the face Phototherapy PHOTODYNAMIC THERAPY

PHOTODYNAMIC THERAPY : 

TOPICAL (ALA) PLUS BROAD-BAND LIGHT (550–700 NM) Inflammatory acne Clinical clearance in 4 weeks Persisted up to 20 weeks Side effects Acneform folliculitis Post inflammatory hyperpigmentation PHOTODYNAMIC THERAPY

PHOTODYNAMIC THERAPY : 

SHORT-CONTACT ALA AND BLUE LIGHT Four weekly treatments moderate to severe acne No noted adverse effects Faster than lasers or light therapy alone PHOTODYNAMIC THERAPY

LASER : 

LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION Pumping source Laser chamber Laser medium CO2 Nd:YAG Delivery system LASER

LASER : 

LASER SAFETY Eye protection glasses Eye cups Inhalation of smoke Face mask Smoke evacuator LASER

LASER : 

Laser Beam Continuous Pulsed Quality switched (Q-switched) LASER

LASER : 

LASER Scaterring Change in direction Absorption Thermal injury

LASERS : 

LASERS Chromophores Absorbs light Selective photothermolysis Target Specific wavelength Short pulse duration Thermal relaxation time

LASERS : 

LASERS

LASERS : 

LASERS Tissue cooling Epidermal melanin Absorb light Direct Back-scattered Cooling the epidermis Heat damage to skin Blistering Dyspigmentation Scarring

LASERS : 

1450-NM LASER Inflammatory acne lesions Thermal damage Upper dermis Sebaceous glands 810-NM DIODE LASER + INDOCYANIN GREEN Sebaceous glands Absorbs indocyanin green LASERS

LASERS : 

CO2 LASER AND ERBIUM:YAG LASERS Laser resurfacing Light strikes skin Heated layer 300°C Vaporization of layer Reepithelialization Atrophic acne scars LASERS

CRYOTHERAPY : 

Cryotherapy Cell death Ice crystals in cell Osmotic differences Cold injury to small blood vessels Immunological stimulation CRYOTHERAPY

CRYOTHERAPY : 

FREEZ-THAW CYCLE Freezing Intracellular ice Thawing Re-crystallization Disrupt cell membranes Ice melts Cell lysis CRYOTHERAPY

CRYOTHERAPY : 

EQUIPMENT Spray method Spray tip size Freeze times Longer Shorter Freeze margin Superficial lesions -3 mm Deep lesions-5 mm Cryoprobe Dipstick technique CRYOTHERAPY

CRYOTHERAPY : 

CRYOTHERAPY METHODS

CRYOTHERAPY : 

LIQUID NITROGEN Temperature -195°C Chronic nodular acne Two freeze–thaw cycles 15–30 s Keloid acne scar CRYOTHERAPY

CRYOTHERAPY : 

Postoperative care Rinse Soap and water Edema Vesicles Bullae Weeping lesion Bandage CRYOTHERAPY

CRYOTHERAPY : 

Complication Pain Analgesics Hypopigmentation Topical steroids Nerve Damage CRYOTHERAPY

CHEMICAL PEELING : 

Controlled application Exfoliating agents CHEMICAL PEELING

CHEMICAL PEELING : 

GLYCOLIC ACID (ALPHA-HYDROXY ACID) Keratolytic Anti-inflammatory Technique Clean the face Apply rapidly 3 min duration Neutralize CHEMICAL PEELING

CHEMICAL PEELING : 

70% GLYCOLIC ACID Weekly Six applications Papulo-pustular Acne Atrophic acne scars CHEMICAL PEELING

CHEMICAL PEELING : 

CHEMICAL PEELING Before 70% glycolic acid After

CHEMICAL PEELING : 

CHEMICAL PEELING Before 70% glycolic acid After

Chemical peeling : 

Post-peeling Complication Burning Itching Hyperpigmentation Infection Contraindication Contact dermatitis Pregnancy Chemical peeling Rare

CHEMICAL PEELING : 

SALICYLIC ACID Keratolytic Comedolytic Anti-inflammatory Antimicrobial Indication Acne Inflammatory Non-inflammatory lesions CHEMICAL PEELING

CHEMICAL PEELING : 

SALICYLIC ACID Contraindications Active inflammation/dermatitis Acute viral infection Pregnancy Isotretinoin therapy 2 weeks before 30% SALICYLIC ACID IN ETHANOL Six peels 2- to 4-week intervals CHEMICAL PEELING

CHEMICAL PEELING : 

CHEMICAL PEELING Before 30% salicylic acid After

CHEMICAL PEELING : 

SALICYLIC ACID Complications desquamation Irritation hyperpigmentation CHEMICAL PEELING Topical steroids

INTRALESIONAL STEROID : 

TRIAMCINOLONE ACETONIDE Cystic acne 2.5 mg/mL Keloids 40 mg/mL Every 2 weeks Local side effects Collagen atrophy Hypopigmentation Skin necrosis Telangiectasia INTRALESIONAL STEROID

DERMABRASION : 

DERMABRASION Mechanical removal Epidermis and dermis Controlled fashion Re-epithelialization 7 to 10 days Indication Atrophic acne scars DERMABRASION

DERMABRASION : 

Technique Clean Freez Abrasion Diamond fraise Depth Pinpoint bleeding (papillary dermis) Whitish yellow (reticular dermis ) Dressing DERMABRASION

DERMABRASION : 

Complications Infections Hypopigmentation Scarring DERMABRASION

SOFT-TISSUE AUGMENTATION : 

Bovine collagen injection Zyderm II Acne scars Skin allergy test Upper reticular dermis Repeat 6 months SOFT-TISSUE AUGMENTATION

SOFT-TISSUE AUGMENTATION : 

SOFT-TISSUE AUGMENTATION Complication Delayed hypersensitivity Granulomatous reactions Sterile abscess Intralesional steroid Oral antibiotics

THANK YOU : 

THANK YOU

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