Transcript بسم الله الرحمن الرحيم "....فعسى ان تكرهوا شيئا ويجعل الله فيه خيرا

‫بسم هللا الرحمن الرحيم‬
ACNE VULGARIS
Objectives:
 Explain etiology and
Pathogenesis of Acne vulgaris.
 Label different types of Acne.
 List available modalities to
treat acne.
 Compare
acne to rosacea.
Acne vulgaris
Definition:
 a chronic inflammatory disease of pilosebaceous unit.
 It is a polymorphic disorder(comedons, papules ,
pustules, nodules, pseudocysts, and sometimes
scarring)
 The sites of predilection face, upper trunk and upper
arms.
 It usually affect adolescent.
 is of multifactorial aetiology.
The etiology and Pathogenesis of
Acne vulgaris:
*These changes occur on a hormonal
background of androgen.
I – Increase sebum production.
II- Obstruction of the pilosebaceous duct
(comedogenesis).
III- colonization of the duct with (P.acnes).
IV- The production of inflammation.
Other factors affecting the
pathogenesis:
A. Endogenous factors
 Genetics.
 Stress and anxiety.++

Menstruation.+
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B- Exogenous factors:
UV. radiation.
Hot humid environment
and sweating.+
Diet.*’’
Occupation.
Clinical Presentation of Acne:
Prevalence: Acne may be the most frequent reason for seeing
a dermatologist, over 90% of males and 80% of females
are affected during there teen age.
Age of onset: Acne develops earlier in females than in males
that may reflect the earlier onset of puberty. Mean age at
onset of acne was 12 ± years in girls and 15± years in
boys.
Sites of distribution:
Acne predominantly affects the face (99%), the back
(60%), chest (15%), and upper arms are also affected.
The types of lesions in Acne:
A – Non inflammatory lesions: (comedones) which
consist of:

Unsightliness.
White heads (closed comedones).
 heads
Psychological
impact.
Black
(open comedones).
B – Inflammatory lesions include:
The superficial lesions are usually papules and pustules.
The deep lesions are deep pustules, nodules and pseudocysts
&
Sinuses
‫ذ‬
Acne varients
1.
2.
3.
Neonatal acne
Persistant acne
Late onset acne.
8.
9.
10.
4.
5.
6.
7.
Acne conglobata
Fulmonant acne
Acne excorié
Gram negative
folliculitis.
11.
12.
13.
Pomade acne
Cosmetic Acne.
Acne venenata.
Drug induced
acne.
Endocrine acne.
Acne astevalis
Neonatal acne
Persistent
acne
Complications of acne:
1- Scarring.
2-Psychological impact.
Types of acne scarring:
Atrophic scars.
Ice pick scars.
Hypertrophic scars.
Keloid scars.
.
Differential diagnosis of acne:
1-Rosocea.
2-Perioral dermatitis.
3-Pitrosporum folliculitis.
4-Folliculitis barbae and Psudofolliculitis barbae.
5-Acneform drug eraption
6-Acneform secondary syphilis.
Treatment of Acne:
A-General measures.
B-Topical treatment.
C-Systemic therapy.
The choice of therapy.
 Mild acne:topical therapy.
 Moderate acne:topical and oral therapies.
 Severe acne: isotretinoin unless it is
contraindicated.
A - General measures:
 Gentle cleansing.
 Avoidness of comedogenic applications.
 Reassurance .
B- Topical treatments:
1- Those directed towards microorganisms.
2- Those directed towards comedogenesis.
1- Topical treatments directed towards
microorganisms:
Topical antibiotics:
 erythromycin (1.5-2% gel or cream).
 clindamycin (1% lotion)
 Benzyl peroxide.
2-Topical treatment directed towards
comedogenesis:
Retinoids:
1- Anti-seborrheic effect.
2- Anti-comedonal effect.
3- Anti-inflammatory effect.
4- Inhibiting the growth of P. acne .
Tretinoin may be used as solution, cream or gel. It is available in
0.025% , 0.05% and 0.1% concentration (2). Tazarotene (0.1% gel)
applied once daily.
Adapalene: Adapalene (0.1% gel).
Azelaic acid: cream with 20%
C) Systemic Treatment of acne:
1-Those directed against microorganisms
(antibiotics).
2-Those directed against comedogenesis and
seborrhea (retinoids).
3-Those acting on hormonal bases (antiandrogens).
Systemic antibiotic:
* Moderate or severe inflammatory acne.
*Acne resistant to topical treatment.
*Acne that covers large area of the body.
Tetracycline: Tetracycline dose for an adult is 250 mg four
times daily.
Doxycycline: It is usually given in a dose of 100 mg once or
twice daily .
Minocyclin: The usual dose is 50-100 mg once or twice daily.
Erythromycin and Azithromysin:
Clindamycin: In a dose of 75-150 mg.
2- Systemic Retinoids:
(Isotretinoin) is the single most effective treatment.
Indications:
1- Severe acne.
2- Moderate unresponsive acne.
3- Acne with scarring.
4- Acne with severe depression or dysmorphophobia.
5- High sebum excretion rate.
6- Some unusual variants, such as acne fulminans,
gram-negative folliculitis .
3- Hormonal therapy:
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Acne is not responding to conventional
therapy.
If there are signs of hyperandrogenism.
A- Androgen production inhibitors: glucocorticoids
and oral contraceptives.
B-Androgen receptor blockers: cyproterone acetate,
spironolactone and flutamide.
acne vulgaris
MILD
Rosacea
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Rosacea (Latin: “like roses”) is a chronic
inflammatoy disorder of the facial
pilosebaceous units, with an increased
reactivity of capillaries to heat, leading to
flushing and telangiectasia...
Age of incidence between 30 to 50 years,
Sex Females predominantly;
Race WHITE peoples.
DISTRIBUTION Characteristic is a a
symmetrical localization on the face
Skin Symptoms/ facial appearance?; Flushing, “heat” in the face.
Stages of Evolution //
episodic (flushing) in response to
(hot liquids), spicy foods; alcohol ,exposure to sun, heat and emotional stress.
*Episodic erythema, “flushing and blushing”
Stage I: Persistent erythema with telangiectases
Stage II: Persistent erythema, telangiectases, papules, tiny pustules
Stage III: Persistent deep erythema, dense telangiectases, papules,
pustules, nodules;
marked sebaceous hyperplasia edema of the central part of the face
"glandular rosacea"
causing disfigurement of the nose {Rhinophyma (enlarged nose) }
Eye Lesions/// “Red” eyes ,chronic
blepharitis, conjunctivitis, and episcleritis.
Rosacea keratitis
Differential Diagnosis
Acne, (note: in rosacea No comedones)
Perioral dermatitis, folliculitis, and SLE
Dermatopathology
1-Dilated capillaries.
2-Marked sebaceous gland hyperplasia
3-Inflammatory infiltrate with foci of
neutrophils within the follicle
4 -epithelioid granuloma without caseation,
Course
Prolonged. Recurrences are common. After a
few years, the disease tends to disappear
spontaneously.
Management
Reduction of alcoholic and hot beverages.
 Topical :\Metronidazole gel or cream, 0.75
%, twice daily orTopical antibiotics (e.g.,
erythromycin gel).
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Systemic: oral antibiotics: Tetracycline,
250mg 4td. until clear; then gradually
reduce to once-daily doses of 250 to 500
mg.
Minocycline and doxycycline, 50 to 100
mg twice daily.
Oral Isotretinoin
Rhinophyma, is treated successfully by
surgery or laser surgery.
Acne
Rosacea
1. ONSET
ADOLESCENCE
THIRTIEs TO FIFTIES
2.SEX
MALE>.F
FEMALES.>MALES
3.SITE
FACE,UPPER TUNCK,
UPPER ARMS
FACE
4.FLUSHING&TELEA _
NGECTASIa
+
5.Comedons
+
_
6.Eye
complecations
7.Rhinophyma
_-----
+
_
+
8.Responce to
treatment
slow
rapid
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