Objectives What is acne? Pathogenesis. Acne lesion. Classification. Clinical variant of acne. What makes acne worse? Differential Diagnosis. Diagnosis. Patient education. Treatment. When to refer.

What is acne? Acne is a disorder of pilosebaceous units of the skin.

Common dermatological disease at primary care. Common dermatological disease at primary care. Mostly affect age group between Mostly affect age group between Affecting male › than female. Affecting male › than female. Have considerable psychological & social consequences. Have considerable psychological & social consequences.

Pathogenesis Excessive sebum production 2ry to androgen(+). Excessive sebum production 2ry to androgen(+). Abnormal follicular keratinization. Abnormal follicular keratinization. Proliferation of propionibactrium acne. Proliferation of propionibactrium acne. Inflammation following chemotaxis & release of proinflammatory mediators. Inflammation following chemotaxis & release of proinflammatory mediators.

Acne Lesion 1ry lesion is microcomedo.

Cont…Acne Lesion Closed comedo(white head)

Cont…Acne Lesion Open comedo.(black head)

Cont…Acne Lesion I II Inflammatory acne lesion: papules & pastules papules & pastules nodules & cysts

Classification SevereModerateMild Numerous- extensive Several Several Few -several Papules/Pastules Many NoneNodules

Clinical variation Neonatal acne Infantile acne

Cont… Clinical variation Teenage acne Adult acne

Cont… Clinical variation Drug induced acne Acne conglobata

Cont… Clinical variation Acne fluminans Gram negative folliculitis

WAIT & SEE

What makes acne worse? Squeezing. Excessive washing. Cosmetics. Equipment e.g. helmets, shirt collar. Premenstrual flare. StressEnvironment Chocolate, sweets & french fries.???????

DDx 1-Rosacea 2-Perioral dermatitis

Cont… DDx 3- Demodex folliculitis 4- pityrosporm folliculitis

Diagnosis History. History. Examination. Examination. Investigation: Investigation: hormonal evaluation. hormonal evaluation. skin biopsy. skin biopsy.

Patient education Describe the cause of acne. Describe the cause of acne. Knowing the aggravating factors. Knowing the aggravating factors. Rx work by preventing lesion Rx work by preventing lesion Rx should apply to all skin. Rx should apply to all skin. No improvement before 6 wks. No improvement before 6 wks.

Treatment Goals of therapy: - control lesion. - control lesion. - prevent scarring. - prevent scarring. - minimize morbidity. - minimize morbidity. - improve life quality. - improve life quality.

Acne therapy by severity Comedonal Acne: Topical Benzoyl Peroxide 2.5-5% Topical Benzoyl Peroxide 2.5-5% Tretinion(Retin-A) % Tretinion(Retin-A) % Adapalene 1% Adapalene 1% Mild Inflammatory Acne: Topical antibiotic (clindamycin, erthromycin) Topical antibiotic (clindamycin, erthromycin) oral antibiotics??? oral antibiotics???

Cont…Acne therapy Moderate Inflammatory Acne: oral antibiotics [essential] oral antibiotics [essential] tetracyclin tetracyclin doxycyclin doxycyclin minocyclin minocyclin Isotretinoin (Accutana) Isotretinoin (Accutana) Severe Inflammatory Acne: Isotretinoin Isotretinoin

Physical treatments Cryotherapy (freezing treatment) Intralesional steroid injections. Cautery or diathermy.

When to refer??? Scarring. Severe inflammatory acne. Serious psychological effect. Moderate acne ẅ not respond to Rx. Acne fluminans, gram –ve folloculitis. Pregnant patient ẅ acne.

Summary ẅ Acne is a multifactorial disease ẅ, although not life threatening, has profound effects on patients. The microcomedo is the 1ry lesion in acne. Reduction of comedones & propionibacterium acnes is the main aim of Rx. Most effective acne regimens treat inflammatory & comedinal acne lesions with a combination of antibacterial & retinoid drugs.

References Acne Vulgaris.BMJ2002;325: Diagnosis and treatment of acne. Am Fam Phys2004;69: Acne and Rosacea: differential diagnosis and treatment in primary care sitting.( Pearls in management of acne. Derma2000; Management acne in adolescents.Ped Derma2000;47: