Transcript Acne
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. Mostly affect age group between 12-24. Affecting male › than female. Have considerable psychological & social consequences. Pathogenesis Excessive sebum production 2ry to androgen(+). Abnormal follicular keratinization. Proliferation of propionibactrium acne. 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 Inflammatory acne lesion: papules & pastules nodules & cysts Classification Mild Papules/ Few -several Pastules Nodules None Moderate Severe Several Numerousextensive Few- several Many 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. Stress Environment Chocolate, sweets & french fries.??????? DDx 1-Rosacea 2-Perioral dermatitis Cont… DDx 3- Demodex folliculitis 4- pityrosporm folliculitis Diagnosis History. Examination. Investigation: hormonal evaluation. skin biopsy. Patient education Describe the cause of acne. Knowing the aggravating factors. Rx work by preventing lesion Rx should apply to all skin. No improvement before 6 wks. Treatment Goals of therapy: - control lesion. - prevent scarring. - minimize morbidity. - improve life quality. Acne therapy by severity Comedonal Acne: Topical Benzoyl Peroxide 2.5-5% Tretinion(Retin-A) .025-.05% Adapalene 1% Mild Inflammatory Acne: Topical antibiotic (clindamycin, erthromycin) oral antibiotics??? Cont…Acne therapy Moderate Inflammatory Acne: oral antibiotics [essential] tetracyclin doxycyclin minocyclin Isotretinoin (Accutana) Severe Inflammatory Acne: 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 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;325:375-9. Diagnosis and treatment of acne. Am Fam Phys2004;69:2123-30. Acne and Rosacea: differential diagnosis and treatment in primary care sitting.(www.medscape.com) Pearls in management of acne. Derma2000;289-309. Management acne in adolescents.Ped Derma2000;47:841-55. www.acne.org www.atlasdermatologico.com.br