prof .atif kazmi
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A C N EA C N E
PROF. SYED ATIF HASNAIN PROF. SYED ATIF HASNAIN KAZMIKAZMI
President Pakistan Association of President Pakistan Association of DermatologistsDermatologists
Dean Faculty of Medicine & AlliedDean Faculty of Medicine & AlliedChairman & Head Department of Chairman & Head Department of
DermatologyDermatologyKEMU/ Mayo Hospital, LahoreKEMU/ Mayo Hospital, Lahore
Prof. Syed Ghulam Shabbir Prof. Syed Ghulam Shabbir (Late)(Late)Founder of Dermatology in PakistanFounder of Dermatology in Pakistan
KING EDWARD MEDICAL UNIVERSITY KING EDWARD MEDICAL UNIVERSITY LAHORELAHORE
MAYO HOSPITAL LAHOREMAYO HOSPITAL LAHORE
ACNEACNE
• Chronic inflammatory disease of the Chronic inflammatory disease of the pilosebaceous follicles seen primarily pilosebaceous follicles seen primarily in adolescentsin adolescents
BASIC LESIONS OF ACNEBASIC LESIONS OF ACNE
Non-inflamed lesionsNon-inflamed lesions
• ComedonesComedones
Inflamed lesionsInflamed lesions
• PapulesPapules
• PustulesPustules
• NodulesNodules
LESIONSLESIONS
• Open comedones (black heads)Open comedones (black heads)
• Closed comedones (white heads)Closed comedones (white heads)
• Inflammatory papulesInflammatory papules
• PustulesPustules
• NodulesNodules
• CystsCysts
• ScarScar
EpidemiologyEpidemiology
• 80% of adolescents and young 80% of adolescents and young adults (11-30 years)adults (11-30 years)
• Both sexes affected, females report Both sexes affected, females report earlierearlier
• 8-10 years8-10 years
Pilosebaceous UnitPilosebaceous UnitMajor FactorsMajor Factors
• Genetic PredispositionGenetic Predisposition
• SeborrhoeaSeborrhoea
• ComedogenesisComedogenesis
• Bacterial colonizationBacterial colonization
• InflammationInflammation
PathPathoogenesisgenesis
PathPathoogenesisgenesis
Aggravating FactorsAggravating Factors
• Drugs: steroids etc.Drugs: steroids etc.
• StressStress
• Occupations: oils, chemicalsOccupations: oils, chemicals
• CosmeticsCosmetics
• Foods ?Foods ?
• Premenstrual flare Premenstrual flare
Clinical FeaturesClinical Features
•Sites:Sites:– FaceFace– BackBack– Anterior trunkAnterior trunk– Upper armsUpper arms
•Pleomorphic lesionsPleomorphic lesions
Moderate
MiId
Severe
GRADINGGRADING
TYPES OF ACNETYPES OF ACNE
ACNE VULGARISACNE VULGARIS
NODULO-CYSTICNODULO-CYSTICACNEACNE
PUSTULAR ACNEPUSTULAR ACNE
PYODERMA PYODERMA FACIALEFACIALE
ACNE CONGLOBATAACNE CONGLOBATA
STEROID ACNESTEROID ACNE
NEONATAL ACNENEONATAL ACNE
ACNE ACNE EXCORIEEEXCORIEE
ACNE AGMINATAACNE AGMINATA
POMADE ACNEPOMADE ACNE
ManagementManagement
• Severity of acneSeverity of acne• Presence or likelihood of scarringPresence or likelihood of scarring• Psychological impact of the diseasePsychological impact of the disease• Experience with anti-acne therapyExperience with anti-acne therapy• PregnancyPregnancy
• Patient educationPatient education
• Removal of aggravating factorsRemoval of aggravating factors
• Pharmaceutical treatmentPharmaceutical treatment
• Adjunct therapiesAdjunct therapies
• Maintenance therapyMaintenance therapy
Management Management ((contd)contd)
Patient EducationPatient Education
Acne isAcne is
• Not infectious/contagiousNot infectious/contagious
• Not caused by poor hygieneNot caused by poor hygiene
• Not to pick/scratch lesionsNot to pick/scratch lesions
• Acne may worsen premenstruallyAcne may worsen premenstrually
• Improvement may take 4-6 weeksImprovement may take 4-6 weeks
• Worsening may occur during early weeksWorsening may occur during early weeks
• Encouragement to continue the Encouragement to continue the therapytherapy
• Whole face needs to be treated and Whole face needs to be treated and not the visible spots onlynot the visible spots only
Patient Education Patient Education ((contdcontd))
Topical TherapiesTopical Therapies
• Retinoids (Retinoids (IsotrexIsotrex))
• Benzoyl peroxide (Benzoyl peroxide (BrevoxylBrevoxyl))
• Antibiotics (Antibiotics (ClinagelClinagel))
• Azelaic acidAzelaic acid
• Combination Drugs e.g. Combination Drugs e.g. IsotrexinIsotrexin------Isotretinoin & Erythromycin and Isotretinoin & Erythromycin and DuacDuac---Clindamycin & Benzoyl ---Clindamycin & Benzoyl PeroxidePeroxide
Systemic TherapiesSystemic Therapies
• Antibiotics (Antibiotics (MinodermMinoderm))
• RetinoidsRetinoids
• DapsoneDapsone
• SteroidsSteroids
Why to use Isotretinoin?Why to use Isotretinoin?
• Nodulocystic, disfiguring, resistant Nodulocystic, disfiguring, resistant acneacne
• Presence or likelihood of scarringPresence or likelihood of scarring
• Psychological distressPsychological distress
• Prevention of suicidal tendencyPrevention of suicidal tendency
Nodulocystic AcneNodulocystic Acne
Nodulocystic AcneNodulocystic Acne
Acne ConglobataAcne ConglobataSevere Form of Nodulocystic AcneSevere Form of Nodulocystic Acne
Severe Form ofSevere Form ofNodulocystic AcneNodulocystic Acne
Acne Acne ConglobataConglobata
Nodulocystic AcneNodulocystic Acne
Isotretinoin TherapyIsotretinoin Therapy
Before After
Isotretinoin Side EffectsIsotretinoin Side Effects
• Many Many General side effectsGeneral side effects have been reported such have been reported such as; dryness of the skin and mucous membranes, as; dryness of the skin and mucous membranes, photophobia, muscle and joint pain, insomnia, lethargyphotophobia, muscle and joint pain, insomnia, lethargy
• Central Nervous System side effectsCentral Nervous System side effects include include pseudotumor cerebri, visual disturbances, hearing pseudotumor cerebri, visual disturbances, hearing deficiencies, headache, nausea, malaise and deficiencies, headache, nausea, malaise and drowsiness, Amnesia, hallucinationsdrowsiness, Amnesia, hallucinations
• Psychiatric disordersPsychiatric disorders include behavioural disorders, include behavioural disorders, seizures, psychosis, schizophrenia, depression, suicide seizures, psychosis, schizophrenia, depression, suicide ideation, suicide attempt and suicideideation, suicide attempt and suicide
• Isotretinoin is also a Isotretinoin is also a teratogenteratogen
DRY EYEDRY EYE
CHEILITISCHEILITIS
Mucocutaneous side effects are inevitable but easily tolerated. The
lips and nose are always affected by drying
Sunburn after Isotretinoin TherapySunburn after Isotretinoin Therapy
Acute paronychia after Isotretinoin Acute paronychia after Isotretinoin therapytherapy
MOOD CHANGE - DEPRESSION
Adjunct therapiesAdjunct therapies
• Skin careSkin care– Normal washing, twice dailyNormal washing, twice daily– Avoid physical scrubsAvoid physical scrubs– Soaps containing chlorhexidine not Soaps containing chlorhexidine not
beneficialbeneficial• Comedo extractor/electrocauteryComedo extractor/electrocautery• Chemical peelingChemical peeling• Microderm abrasion/Laser ResurfacingMicroderm abrasion/Laser Resurfacing• Fillers Fillers
Course and PrognosisCourse and Prognosis
• Mostly clear by early twentiesMostly clear by early twenties
• Some may continue in third/fourth Some may continue in third/fourth decadedecade
• Residual scarringResidual scarring
MythsMyths
• Acne only appears during teenageAcne only appears during teenage• Marriage will improve acneMarriage will improve acne• Acne should not be treatedAcne should not be treated• Spicy foods, eggs, mangoes cause Spicy foods, eggs, mangoes cause
acneacne• Betnovate/Archi/Stillmans improve Betnovate/Archi/Stillmans improve
acneacne
THANK YOUTHANK YOU
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