acne

ACNE VULGARIS

Abdul Alraiyes

5/7/08

ACNE VULGARIS

SELF-LIMITED DISORDER OF PILOSEBACEOUS UNIT

PRIMARILY IN ADOLESCENTS

PLEOMORPHIC VARIETY OF LESIONS- COMEDONES,

PAPULES, PUSTULES, NODULES

GENETIC FACTORS PLAY A ROLE IN ACNE SEVERITY

MEDICATIONS LIKE CORTICOSTEROIDS, ISONIAZID,

PHENYTOIN, LITHIUM, PROGESTINS

CAN CAUSE ACNELIKE LESIONS

PATHOGENESIS

FOUR KEY ELEMENTS:

FOLLICULAR HYPERKERATINIZATION

SEBUM ACCUMULATION

INFLAMMATION

PRESENCE & ACTIVITY OF Propionibacterium acnes

ANDROGENS PLAY A PIVOTAL ROLE

INCREASE SEBUM PRODUCTION & ENLARGE SEBACEOUS GLANDS

CLINICAL FEATURES

OPEN & CLOSED COMEDOS, ERYTHEMATOUS

PAPULES, PUSTULES, NODULES, CYSTS &

SCARS

FACE, TRUNK & CHEST

INFLAMATORY & NON-INFLAMMATORY LESIONS

SCARRING IS A COMPLICATION OF BOTH.

CLINICAL VARIANTS OF ACNE

ACNE

CONGLOBATA: severe, scarring form of

acne where large

nodules and abscesses

become confluent to

form draining sinus

tracts

ACNE CONGLOBATA

CLINICAL VARIANTS OF ACNE

ACNE COSMETICA:persistent, low grade form

of acne result from use of

cosmetics, moisturizers,

sunscreens This type of

acne responds particularly

well to the topical

application of tretinoin.

CLINICAL VARIANTS OF ACNE

ACNE MECHANICA:results from repeated trauma

associated with sports

helmet, shoulder pads, chin

rests of violoins and violas.

CLINICAL VARIANTS OF ACNE

Acne fulminans : severe, scarring form of acne

with systemic signs and

symptoms of infection and

Leukocytosis.

CLINICAL VARIANTS OF ACNE

NEONATAL ACNE &

INFANTILE ACNE

CLINICAL VARIANTS OF ACNE

STERIODS ACNE

DIFFERENTIAL DIAGNOSIS

FOLLICULITIS :PAPULES, PUSTULES,

NO COMEDOS. USUALLY

AFFECTS TRUNK &

EXTREMITIES

DIFFERENTIAL DIAGNOSIS

PERIORAL

DERMATITIS: LONG

TERM USE OF TOPICAL

CORTICOSTEROIDS ON

FACE CAN RESULT IN

ACNEIFORM,

ERYTHEMATOUS,

INFLAMED PINK PAPULES

ON CHIN & CHEEKS.

DIFFERENTIAL DIAGNOSIS

MILIA : WHITE, PINPOINT

EPIDERMAL CYSTS AROUND

EYES

TREATMENT

TOPICAL THERAPY:

Comedonal acne: Topical retinoids –tretinoin, adaplene, tazarotene

Anti-inflammatory & reduce follicular hyperkeratinization

Inflammatory acne: Topical antibiotics with benzoylperoxide & topical retinoids

Azelaic acid : antimicrobial & comedolytic properties

Salicylic acid

TREATMENT

SYSTEMIC THERAPY

Antibiotics: A trial of 8-12 weeks is warranted to assess responsiveness.

Doxycycline, minocycline, trimethoprim-sulfamethoxazole

Isotretinoin: Cases of Refractory deep inflammmatory acne vulgaris

Hormonal therapy: OCPs , spironolactone

Intralesional glucocorticoids; deep nodular lesions

THANKS