Presentation is loading. Please wait.

Presentation is loading. Please wait.

ACNE Definition Inflammation of sebaceous follicles Follicle

Similar presentations

Presentation on theme: "ACNE Definition Inflammation of sebaceous follicles Follicle"— Presentation transcript:

1 ACNE Definition Inflammation of sebaceous follicles Follicle
sebaceous gland follicular canal hair

2 ACNE Classification comedonal acne mild inflammatory acne
moderate inflammatory acne severe inflammatory (nodulocystic)

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

4 ACNE Pathogenesis 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

5 Acne lesions at a glance

6 ACNE Lesions Inflammatory and comedonal acne

7 ACNE Lesions Open comedones are evident on the chin

8 ACNE Lesions inflammatory and comedonal acne

9 ACNE Therapy (Mechanisms)
Hormonal regulation Sebum suppression Keratolysis and inhibition of follicular proliferation Antibacterial / antiinflammatory

10 Hormonal regulation Oral contraceptives Spironolactone
particularly estrogen predominant Ortho-Tri-Cyclen Spironolactone

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

12 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)

13 ACNE Topical retinoids
Contemporary Peds Dec. 2000

14 ACNE Adapalene (Differin)
Derivative of Naphthoic acid Has more specific retinoid receptor activity Some studies have shown less irritation

15 ACNE Azelaic 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

16 Antibacterial / antiinflammatory
Topical Erythromycin Clindamycin Oral Tetracycline Doxycycline Minocycline

17 ACNE Topical antibiotics
Contemporary Peds Dec. 2000

18 ACNE Oral Antibiotics Contemporary Peds Dec. 2000

19 ACNE therapy (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

20 ACNE Counseling 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)

21 ACNE Counseling 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

22 ACNE Treatment Plans

23 ACNE Treatment Plans

24 ACNE Treatment Plans Consultant April 1999

25 ACNE When 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

26 ACNE Treatment Plans

27 ACNE Treatment Plans Contemporary Peds Dec. 2000

28 ACNE Treatment Plans

29 ACNE Treatment Plans Contemporary Peds Dec 2000

30 ACNE Treatment Plans

31 ACNE Treatment Plans Contemporary Peds Dec 2000

32 ACNE References (required reading)
Pediatric Clinics North America August 2000 Contemporary Pediatrics Dec 2000 Pediatric Annals January 2000 Available in the Peds Office

Download ppt "ACNE Definition Inflammation of sebaceous follicles Follicle"

Similar presentations

Ads by Google