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Back to Medical School
18th October 2012 - Acne
The acne disease pathway
Androgen
hormone
influences and
stimulates
sebaceous gland
Sebaceous glands
enlarge
Over production of
epithelial cells lining
follicles
1
Excessive sebum
production
Hyperkeratinization
2
Microcomedone
formation
A thick
hyperkeratotic plug
Scars
3
Inflammation and
immune response
Formation of pustules
and cysts
Propionibacterium
acnes colonization in
anaerobic environment
Pathogenic factors of acne
1. Excessive sebum production
4
2. Hyperkeratinization (abnormal cell turnover)
3. Inflammation and immune response
4. P. acnes colonization
Goal of treatment: To target as many pathogenic
factors of acne as possible
White heads and
black heads form
Actions of Anti-Acne Therapies
Topical retinoids
and naphthoic acid
derivatives:
 Normalize desquamation
Benzoyl
peroxide:
 Kills
microorganisms
 Keratolytic
Oral Isotretinoin:
 Reduce inflammatory
response
 Reduces sebum
 Normalizes
desquamation
 Inhibits P acnes
 Reduces inflammatory
response
Antibiotics:
 Kills microorganisms
 Reduce inflammatory
response
Hormones:
 Reduce sebum
production
Skin care for acne patients
• No need to overdose on cleansing!
• Soap free cleansing/soap substitute washes
• Use non-comedogenic cleansers, make up and
moisturisers (oil free)
• Avoid greasy products
• Educate re squeezing and associated scarring
When to Refer
Criteria for referral
• Severe nodulo-cystic acne (refer immediately)
• Risk/evidence of scarring and postinflammatory hyperpigmentation (PIH)
• Moderate acne that has failed to respond to 2
or more courses of treatments
• Mild to moderate acne in patients who have
extreme psychological distress
Galderma Nurse Team
Acne Academy Website
www.acneacademy.org