Transcript Acne and Rosacea

Acne and Rosacea
Dr. D. Czarnecki MD MBBS
Acne
• It is a disease of Western societies.
• Young migrants from the Third World develop acne
when they eat the food of their new First World
homes.
• Acne patients who change their diets improve.
• Starvation will clear acne.
Acne
• Androgens cause the sebaceous glands to enlarge
and produce sebum. Acne occurs at puberty.
• The Western diet affects insulin secretion.
• Insulin has a direct effect on the sebaceous glands
and insulin influences the amount of unbound (free)
testosterone in the serum
• Stress causes the adrenal glands to release more
androgens and these aggravate acne.
Acne
• Insulin – causes the sebaceous glands to enlarge
• There is an increase in the amount of free
testosterone because of insulin.
• The increase in testosterone makes the sebaceous
glands enlarge, block, and rupture.
• The contents of the ruptured gland cause
inflammation
Sebum on the skin
protects the skin
Androgens
Sebum
Cells produce
Sebum
Sebaceous gland
Sebaceous glands enlarge and produce sebum at puberty.
Androgens are the main hormones influencing sebaceous gland
metabolism.
Insulin also has an important effect
Abnormal keratinization
Altered sebum
bacteria
Sebaceous gland
Abnormal keratinization occurs and the sebaceous glands are obstructed.
Bacteria proliferate in the anaerobic environment.
The composition of sebum is altered, it is more likely to cause inflammation.
Obstruction
Sebum causes
inflammation
Altered sebum
bacteria
Sebaceous gland
ruptures
Obstructed sebaceous dilate and rupture..
The altered sebum causes inflammation in the dermis.
Acne
• Most patients will clear with:
• An ANTI-INFLAMMATORY ANTIBIOTIC
• And a COMEDOLYTIC
• There is no special facial wash – black heads are
caused by compressed keratin, not by dirt
• No greasy products on the skin or scalp – these will
be smeared on the face and can obstruct the glands
• Consider the anti-acne diet but it will interfere with a
normal social life
Acne
• Some antibiotics have anti-inflammatory properties.
These include:
• Tetracycline
• Vibramycin
• Minomycin
• Cotrimoxazole
• Erythromycin
• The dose must be adequate
Acne
• COMEDOLYTICS
• Remove the obstructions in the sebaceous gland
• There are several compounds:
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Benzoyl peroxide
Retinoic acid
Azelaeic acid
Adapalene
Acne
• Other effective therapies are:
• ANTI-ANDROGENS
• ISOTRETINOIN
• Acne does not respond to such things as zinc
capsules
Acne
• Cyproterone acetate is an anti-androgen
• The dose is 50 mg for 10 days a month
• (days 5 to 14 of the cycle)
• The pill should to be taken to keep the
• cycle regular.
Warn the patient that staining may
be left. This will fade overtime.
Cystic acne – this is a bad prognostic sign. Most patients
will have acne for decades and be left with many scars
isotretinoin is the most effective drug for cystic acne
Cystic acne – many scars are left where there were cysts
Acne
• Isotretinoin is the most effective agent
• The course is for 5 months
• The dose should be 1 mg per Kg a day
• The side effects are well tolerated
Rosacea
• A common eruption,
more common with age
• There is inflammation
but no obstruction of
sebaceous glands
• Papules, pustules,
diffuse erythema, and
possible induration of
the affected area
• No black heads
Rosacea
• Rosacea looks like acne but it is caused by
• leaking blood vessels
• Treatment consists of:
• ANTI-INFLAMMATORY ANTIBIOTICS
• in an ADEQUATE DOSE Metronidazole is effective
• Topical antibiotics are not very effective
• Protection from the sun – UVL aggravates it
Acne – sebum in the skin
causes inflammation
Sebaceous gland ruptures
Rosacea – blood vessels leak
Rosacea-like eruption
• Fluorinated steroids used on the face for long
periods cause a rosacea like eruption.
• Only use 1% hydrocortisone on the face for long
periods.
• Treatment –
• ANTI-INFLAMMATORY ANTIBIOTICS
• in an ADEQUATE DOSE