ACNEDefinition

Inflammation of sebaceous follicles Follicle

sebaceous gland follicular canal hair

ACNEClassification

comedonal acne mild inflammatory acne moderate inflammatory acne severe inflammatory (nodulocystic)

ACNEPathogenesis

Pubertal changes increased sebaceous production of sebum abnormal sloughing of follicular wall lining closed comedone (whitehead) open comedone (blackhead)

ACNEPathogenesis

Accumulation of Propionobacterium acnes (normal skin flora)

metabolization of sebum release of free fatty acids

attraction of neutrophils rupture of follicular wall extrusion into the dermis

inflammatory lesions papules, pustules nodules, cysts

Acnelesions at a glance

Inflammatory and comedonal acne

ACNELesions

Open comedones are evident on the chin

ACNELesions

inflammatory and comedonal acne

ACNELesions

ACNETherapy (Mechanisms)

Hormonal regulation Sebum suppression Keratolysis and inhibition of follicular

proliferation Antibacterial / antiinflammatory

Hormonal regulation

Oral contraceptives particularly estrogen predominant Ortho-Tri-Cyclen

Spironolactone

Sebum suppression

Isotretinoin (Accutane) oral synthetic Vitamin A analog shrinks sebaceous gland

Keratolysis and inhibition of follicular proliferation

OTC preparations salicylic acid (Stridex) Benzoyl Peroxide

Isotretinoin (Accutane) Topical retinoids

tretinoin (Retin-A) adapalene (Differin) tazarotene (Tazorac)

Azelaic Acid (Azelex)

Contemporary Peds Dec. 2000

ACNETopical retinoids

ACNEAdapalene (Differin)

Derivative of Naphthoic acid Has more specific retinoid receptor

activity Some studies have shown less irritation

ACNEAzelaic Acid (Azelex)

Dicarboxylic acid produced by P. ovale demonstrated activity against P. acne demonstrated ability to inhibit microcomedo Prevents hyperpigmentation

inhibits tyrosinase (melanin synthesis) adresses postinflammatory hyperpigmentation

Antibacterial / antiinflammatory

Topical Erythromycin Clindamycin

Oral Tetracycline Doxycycline Minocycline Erythromycin

Contemporary Peds Dec. 2000

ACNETopical antibiotics

Contemporary Peds Dec. 2000

ACNEOral Antibiotics

ACNEtherapy (vehicle effects efficacy)

Creams Less potent than gels Less drying than gels

May not be good for the patient with oily complexion

Gels, solutions more drying tend to cause more

irritation oily skin

ACNECounseling

Poor hygiene is not a cause of acne Effect of diet has not been demonstrated 4 – 6 weeks of treatment before any improvement

is expected Warn patients about skin irritation

BP, topical retinoids Warn patients about photosensitivity

topical retinoids, tetracycline, Doxycycine apply at night consider noncomedogenic sunscreen (SPF =15)

ACNECounseling II

Apply topical therapy to entire region not just to lesion Start at low dose, infrequent applications and

increase gradually Apply to thoroughly dried skin

30 minutes of air-drying not right after washing your face

Avoid cosmetics, mechanical friction harsh scrubbing tight chin straps, caps bangs

ACNE Treatment Plans

ACNE Treatment Plans

Consultant April 1999

ACNE Treatment Plans

ACNEWhen to refer

No improvement despite therapy Cysts or scars

sometimes require intralesional steroids Consideration of Accutane or

spironolactone Associated menstrual irregularity or

hirsutism polycystic ovarian syndrome

ACNE Treatment Plans

Contemporary Peds Dec. 2000

ACNE Treatment Plans

ACNE Treatment Plans

Contemporary Peds Dec 2000

ACNE Treatment Plans

ACNE Treatment Plans

Contemporary Peds Dec 2000

ACNE Treatment Plans

Available in the Peds Office

ACNEReferences (required reading)

Pediatric Clinics North America August 2000

Contemporary Pediatrics Dec 2000

Pediatric Annals January 2000