Acne

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Presentation Transcript

Acne Vulgaris: 

Acne Vulgaris Dr.Kaushik

Acne Rosacea: 

Acne Rosacea Most common in people age 30-60 Cause of vascular dilation unknown Initial symptom is erythema of the face Treat symptoms Topical antibiotics and benzoyl peroxide Tretinoin & oral Abs for persistent Sx

Pathogenesis… 4 factors: 

Pathogenesis… 4 factors Hyperkeratosis Increased sebum production Propionibacterium acnes present in the follicle Inflammation

A zit’s a zit…right?: 

A zit’s a zit…right? Open comedo = blackhead Follicle is open and distended Dark color is due to melanin, lipids, and keratinocytes Closed comedo = whitehead Progresses from microcomedo due to sebum production

Closed OpenComedo Comedo : 

Closed Open Comedo Comedo

Open comedones: 

Open comedones

Inflammatory lesions: 

Pustules (superficial), papules, nodules Develop when follicular contents rupture into surrounding dermis Inflammatory lesions papules

What about adults?: 

What about adults? Acne tends to resolve in the 3rd decade Due to DHEA decline Premenstrual flares are common in older women

What was that about DHEA?: 

What was that about DHEA? Androgens in general are the original culprit Leads to pubertal production of sebaceous glands and sebum Also, some androgens are active on the skin leading to increased metabolic activity in acne-prone areas of the skin

Acne medicamentosaacne fulminans acne conglobata: 

Acne medicamentosa acne fulminans acne conglobata

External factors: 

External factors Acne comsetica Recommend water-based products Acne mechanica Mechanical trauma may lead to inflammatory lesions “Sports induced”

External factors: 

External factors Clothing can harm Pts with acne should avoid occlusive clothing Environmental factors Humidity & heavy sweating, halogenated hydrocarbons from industrial products (cutting oils, herbicides, chemical warfare) Dietary factors are usually not of concern

Clinical presentation: 

Clinical presentation Affects face, neck, chest, upper back, upper arms Greatest number of sebaceous glands Scarring and hyperpigmentation may occur

Diagnostic evaluation: 

Diagnostic evaluation Refer for endocrine evaluation to rule out systemic causes PCOShyperandrogenism Check med list May be caused by androgens, corticosteroids, lithium, phenytoin, B vitamins, etc.

Diagnosis: 

Diagnosis Focus on type & location of lesions, scarring, & postinflammatory pigment changes Hirsutism or virilization warrants further lab & imaging studies

Keys to Clearing Acne: 

Keys to Clearing Acne Controlled not cured Patient must want to comply Takes 4-8 weeks to see full effect Long-term, consistent and continuous

Type of acne to self treat: 

Type of acne to self treat Non-Inflammatory (less than 10 comedones) goals unblock ducts and keep orifice open relieve social and physical discomfort

When to Refer: 

When to Refer Moderate to severe papular, postular and nodule acne (10-25 inflammatory lesions) Scars On chest or back Not typical age Due to Medication use

Non Pharmacological: 

Non Pharmacological Cleanse the skin warm water, soap, not vigorous Minimizing factors avoid friction causing clothes no oil based cosmetics sun exposure don’t pick or squeeze

OTC products: 

OTC products Benzoyl Peroxide Salicylic Acid Sulfur (w/ resorcinol)

Benzoyl Peroxide: 

Benzoyl Peroxide Bacteriocidal against P. acnes Increase sloughing of skin cells Prevents closure of orifice Use 1-2 times daily (4-6 weeks for full effect)

Benzoyl Peroxide: 

Benzoyl Peroxide Excessive dryness, peeling May bleach clothes, bedding Category III (not enough data)

Salicylic Acid: 

Salicylic Acid Mild comedolytic agent surface keratolytic Apply 1-3 times daily

Sulfur: 

Sulfur Keratolytic Comedolytic use 1-3 times daily color and odor

Product selection: 

Product selection Gels vs. Creams Strength

Questions: 

Questions