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