Management of Acne – 1Management of Acne – 1 where do we stand ? where do we stand ?

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IntroductioIntroductionn

• Common disease of pilosebaceous unit Common disease of pilosebaceous unit in adolescentin adolescent((PhysiologicPhysiologic).).

• Its cause is multi factorial & has Its cause is multi factorial & has pleomorphic clinical presentation.pleomorphic clinical presentation.

• Different modality of treatment are Different modality of treatment are available, but selection of appropriate available, but selection of appropriate method is method is Vital.Vital.

NaturalNatural historyhistory

• Starts at adolescent-resolve by mid-twentiesStarts at adolescent-resolve by mid-twenties

• 83-95% suffers - at about 14-19years of age83-95% suffers - at about 14-19years of age

• 8% late onset acne - 0ver 25years age8% late onset acne - 0ver 25years age

Intro FactorsductionIntro Factorsduction

• Genetics Genetics • EnvironmentalEnvironmental• Sebum- Sebum- 1.Triglycride is hydrolysed by P.acnes to 1.Triglycride is hydrolysed by P.acnes to free fatty acidfree fatty acid, ,

2. increased 2. increased squalenesqualene,& 3.decreased ,& 3.decreased Linoleic acidLinoleic acid

• P.acnes- P.acnes- lipase, phosphatase & hyaluronate lyaselipase, phosphatase & hyaluronate lyase

• Ductal keratinocyte- Ductal keratinocyte- IL-1IL-1,IL-1,IL-1ββ, TNF , TNF

Major pathological events in acneMajor pathological events in acne

Special features of pilosebaceous unitSpecial features of pilosebaceous unit

• Propionibacterium acnesPropionibacterium acnes -unique composition of sebum-unique composition of sebum

• Release of Release of IL-1IL-1,IL-1,IL-1ββ, TNF from ductal keratinocytes, TNF from ductal keratinocytes

• Androgen receptors Androgen receptors – Keratinocytes of hair follicle & Basal – Keratinocytes of hair follicle & Basal cells of sebaceous unitcells of sebaceous unit

• Follicular keratinocytes has – Follicular keratinocytes has – increasedincreased 1717ββ-hydroxysteroid dehydrogenase -hydroxysteroid dehydrogenase && 5-reductase5-reductase

activity (Type-I isoenzymeactivity (Type-I isoenzyme))[[pivotal in development of pivotal in development of

sebaceous gland and acnesebaceous gland and acne]]

Factors responsible for Factors responsible for Keratinocyte hyperproliferationKeratinocyte hyperproliferation

• Androgenic hormone Androgenic hormone Dihydrotestosterone (DHT)Dihydrotestosterone (DHT)

• Decrease Linoleic acidDecrease Linoleic acid

• Increased Interleukin (IL)-1 Increased Interleukin (IL)-1

Management of Acne Part – 2 (Coming Management of Acne Part – 2 (Coming Soon) Soon)

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