Transcript ACNE.pps

ACNE
Disorders of sebaceous gland
Omar Abdulaziz Al-Sheikh, M.D.
College of Medicine
King Saud University
Definition:
Is a chronic inflammatory disorder of the
pilosebaceous apparatus of certain body area
(Face> Torso > rarely the Buttocks), resulting in
greasiness and polymorphic skin eruption.
Incidence:
Acne affect all skin types, the male and female
ratio is virtually the same but tend to be more
severe in males.
85% affect the age group 12 – 24 years
8% affect the age group 25 – 34 years
3% affect the age group 35 – 44 years
Etiology:
1.
2.
3.
4.
Genetic Aspect, (Acne runs in family) other
example the case of severe acne that is
associated with XXY syndrome.
Occupation (Environmental, Mechanical) e.g.
exposure acnegenic mineral oil (Pomade acne)
dioxin
Drugs Oral and topical Hydrocortison (Steroid
acne) Lithium, Hydantoin, contraceptives
Endocrine Factors (Recalcitrant Acne, POD/s,
MARSH Syndrome) .
Pathogenesis:
( three main steps recognized
and hypothesized)
1. Follicular Hyperkeratosis (the cause not fully
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understood) theory suggest:
deficiency in Linoleic acid,
the effect off 5-a reductase enzyme on
converting Androgen (Testosterone) hormone
to the active acnegenic and potent
(Dihydrotestosterone) DHT,
the direct effect of Interleukin-1 on follicular
hyperkeratosis
Fig 1
Fig 2
Fig 3
Perifollicular Hyperkeratosis
histology
Seborrhoea is a common feature between
patients with acne.
2. Abnormal production of abnormal sebum
increasing the ratio of wax easter to
cholesterol and cholesterol easter and is
believed to be the response of sebaceous
glands to DHEA
3. Colonization of the affected unit with
bacteria Propionibacterium acne and
yeast named Malassezia furfur
Fig 4
Malassezia furfur
Fig 5
Propionibacterium acne
P
acne is potent activator of complement via
classical pathway
Fig 6
Fig 7
Propionobacterium acne lipases act on sebaceous
fatty acid (Triglycrides) to release irritant free
fatty acid and low-molecular- weight peptide an
extra cellular factor that penetrate the follicular
wall and stimulate Polymorphs and Lymphocytes
initiating inflammation
Fig 8
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Hydrolytic enzymes released from the activated
complement antibodies complex together with
exoenzymes produced from P acne cause
rupture of follicular wall
Fig 9
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Once the wall is damaged Various agents
(prostaglandin-like substance, amino acid, short
chain fatty acid are) that are produced by the
inflammatory cells and P acne extrude to the
dermis causing more inflammation
Clinical features:
(Acne and acne related
Disorders)
Acne Vulgaris:
Papules: (Less than 0.5 cm)
1.

Comedones (Open “Blackheads” or closed
“Whitheads”)
Open Comedones (Blackheads)
Fig 10
Fig 11
Open Comedones
Closed Comedones (Whitehead)
Fig 12
Fig 13
Closed Comedones
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Inflammatory papules
Fig 14
Fig 15
Inflammatory papules
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Pustules :
Fig 16
Fig 17
Pustules
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Nodule (more than 0.5 cm)
Fig 18
Fig 19
Nodule
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Cystic acne: the cysts are usually large 14cm
Fig 20
Fig 21
2. The nodules and cysts could be associated with
sinuses as in Acne inversea
 Acne inversea (Hidradinitis supprativa “a misleading
name”) because it is considered by some to be disorder
of apocrine gland (Sweat gland) but In my opinion Acne
inversea affect primarily pilo Seb. Unit and affect
secondarily the sweat gland, hence the correct name
Acne inversea rather than Hidradinitis supprativa is
preferred.
Fig 22
3. Neonatal Acne and Infantile Acne

Neonatal acne: cause unknown but some
believed is due to passing of Transplacental
androgen other suggest the role of Mlalassezia
furfur and sympodalis . affect 1 in 5 mainly
inflammatory comedones on nose and cheeks
affect new born between the 1st and 6th week of
age
Fig 23
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Infantile Acne: affect males more than females,
usually between 3 and 6 months of age, and
tend to be severer than the neonatal one and
believed to be due to Endogenic androgen from
the infant’s gonads.
Fig 24
4. Recalcitrant Acne
Affect Women and associated with (Adrenal
hyperplasia "11-B- or 21-B hydroxlase
deficiencies) acne is usually nodulocystic
5. Acne Fulminans
Affect youngsters 13 – 17 years of age, very
severe with ulceration and puss discharge,
associated symptoms include (fever malase
myalgia arthritis and bone pain) laboratory
investigation shows ESR
Can be induced by starting the patient on high
dose of isotretinion (Roaccutane).
Fig 25
6. Acne Conglobata
Very severe Acne, Nodulocystic form with abscess
formation, affect Torso more than the face,
usually associated with XYY Syndrome.
Fig 26
Fig 27
7. Acne Agminata (Lupus Milliaris Disseminatus Faciei)
Some believe it is form of Rosacea (Granulomatous
type), diagnosis is made at Histological base,
Caseating Granulomata at the dermal level.
Fig 28
8. Acne as part of other syndromes
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MARSH Syndrome (Melsma, Acne, Rosacea,
,Seborrhoeic eczema, and Hirsutism)
Acne Conglobata
Favre Racouchot syndrome elderly with elastosis as part
of Helioderma, sun exposure is a predisposing factor.
Polycystic ovarian syndrome
Atrophoderma vermiculatum as part of so called
Ulerythema ophryogenes triat in Noonan Syndrome, de
Lange Syndrome, and Rubinstein-Taybi Syndrome Not
considered acne
9. Occupational
I Environmental
Chloracne rare forms of acne affect patients
exposed to Halogenated Hydrocarbons or who
ingested Chlorinated Phenols (Dioxin)
 Pomade acne or known as Oil Folliculitis
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Acne Aestivalis or so called Mallorca Acne
Occupational
II mechanical acne
Folicullitis Nuchae or so called Acne Keloidalis
 Pseudofollicultis barbae
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Acne excoriee as part of Psychodermatosis
TRAETMENT
Note: All medications used for the treatment of acne act
as:
1. Anti comedonal
2. Anti inflammatory
3. Anti microbial
Topical Keratolytic
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Retinoid ( Retinoic acid 0.025, 0.05, 0.1%)
Adapelene (Diffrine 0.1%)
Salicylic acid
Benzoic acid
Azelaic Acid (10, 15, 20 %)
Topical Antibiotic
Topical clindamycin (Dalacin T)
 Erythromycin
 Mupirocin (Bactroban)
 Sodium Fusidic acid (less significant in the
treatment)
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Systemic therapy
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1.
2.
3.
4.
5.
6.
Antibiotic (Macrolides and Tetracyline)
Tetracycline
Doxycycline
Minocycline (Photo sensitivity and LE)
Erythromycines
Clarythromycines
Azithromycine
Systemic Retinoid
Isotretinoine caps (Roaccutane)
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New promising and potentially safe medication
SMT D002
Phase I clinical trial
Is believed to treat seborrhoea a symptom of
Parkinson's disease and the primary cause of
acne
Other form of therapy
Systemic steroid (Prednisolone) acne fulminans
and intralesional steriods for forms of cystic
acne.
 Photodynamic therapy i.e. Laser therapy and
phototherapy (Less significant)
 Hormonal therapy (Antiandrogen)
Spironlacton (Potassium sparing agent) and
Metformin as (Hypogylcemic agent) in treatment
of POS have good results on acne
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Fig 1, 2 www.scf-online.com/.../keratinization38_e.htm keratinization of the duct of the hair follicle.
www.nlm.nih.gov/.../ency/imagepages/2087.htm open (Blackheads) comedones, Medical Encyclopedia
Fig.3
Fig 4. Malassezia furfur www.doctorfungus.org/thefungi/Malassezia.htm Closed comedones Skin and
allergy centre.
Fig 5
Fig 6 www.ohiohealth.com/bodymayo.cfm?id=6&action=t... Mayo Foundation for Medical and research.
Fig 7
Fig 8 bacterial colonization www.healthcaresouth.com/pages/acnewhatis.htm
Fig 9 Breakage of follicular wall www.healthyskinbydesign.com/acne.cfm papule
Fig 10 open comedones www.healthcaresouth.com/pages/acnewhatis.htm
Fig 11
Fig 12 closed comedones www.healthcaresouth.com/pages/acnewhatis.htmfig
www.dermalogix.net/acne/acne.html open and closed comedones schematic pictures
www.dermalogix.net/acne/acne.html proriobionacterium acne in pilosabaceous unit
www.healthyskinbydesign.com/acne.cfm. follicular hyperkeratosis in acne
Fig 13
Fig 14
Fig 15
Fig 16 www.healthyskinbydesign.com/acne.cfm pustule
Fig 17. Courtesy of Skin and allergy centre
Fig 18 www.healthyskinbydesign.com/acne.cfm nodule
Fig 19 nodule www.acnekil.com/What's_Acne/photo_gallery2.htm
Fig 20
Fig 21 Courtesy of Skin and allergy centre
Fig 22 Courtesy of Skin and allergy centre
Fig 23 www.adhb.govt.nz/.../BenignLesions.htm at neonatal dermatology benign lesions Auckland
district health board.
Fig 24 http://www.virtualendocrinecentre.com/diseases.asp?did=860 (infantile)
Fig 25
Fig 26 Courtesy of Skin and allergy centre
Fig 27 Acne conglobata www.consultantlive.com/showArticle.jhtml?arti...
Fig 28 acne Agminata Granulomatous rosacea in infants. Report of three cases and discussion of the
differential diagnosis João Borges da Costa, Sousa Coutinho V, L Soares de Almeida, M Marques
Gomes PhDDermatology Online Journal 14 (2): 22
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