Transcript Acne - ATSU
Acne
Bill V. Way, D.O.
Dermatology Residency
Program Director
What is Acne?
Acne is a skin disorder resulting from
the action of hormones on the skin’s oil
glands (sebaceous glands) which leads
to plugged pores and outbreaks of the
lesions of papules, pustules,
comedones, inflammatory cysts
commonly called pimples or zits.
Acne
Over 17 million people in the US have
acne today. It is the most common skin
disease.
Not a serious health threat, but severe
acne can lead to disfiguring, permanent
scarring, low self esteem.
Acne
The disease of the pilosebaceous units
of the skin.
Most commonly on the face, neck,
chest, back and shoulders were more of
the pilosebaceous units are located.
Acne
The basic acne lesion is called the
comedo (KOM-e-do), simply an
enlarged and plugged hair follicle.
If it remains below the surface it is
called a closed comedo and produces a
whitish bump called a whitehead, this is
not a milium.
Acne: Comedo
If the comedo reaches the surface, it is
called an open comedo or blackhead
The black color is not dirt, but is from
the oil oxidizing when it reaches the
surface of the skin
Acne: Papule
Inflammed lesions that usually appear
as small pink bumps on the skin and
may be tender to the touch
Acne: Pustule
Inflammed papules with a pustule on
the top that may be red at the base and
usually tender. (Pimple)
Acne: Nodules
Large, painful, solid lesions that are
lodged deep within the skin
Acne: Cysts
Deep,painful, pus-filled lesions that can
cause scarring
What causes Acne?
Exact cause of acne is unknown.
Several factors may play a role.
One important factor is an increase in
androgens (male hormones). These
increase in both boys and girls during
puberty and cause the sebaceous
glands to enlarge and make more
sebum.
What causes Acne?
Other factors: heredity or genetics;
medications, androgens, lithium; greasy
cosmetics; occlusive clothing
Hormone changes related to pregnancy
or starting and stopping birth control
pills can also be a cause of acne.
What causes Acne?
Propionibacterium acnes (P.acnes) are the
anaerobic bacteria responsible for causing
acne.
Other factors: heredity or genetics;
medications, androgens, lithium; greasy
cosmetics; occlusive clothing
Hormone changes related to pregnancy or
starting or stopping birth control pills can also
be a cause of acne.
Propionibacterium acnes
Anaerobic bacteria in hair follicle.
These bacteria use the sebum as food and
break the sebum down into irritating
substances, which cause inflammation.
The abnormal flaking of the cells inside the
hair follicle and the irritating substances lead
to a plug formation and the to follicle swelling
and then rupturing and developing into the
papule then to the pustule.
What can make Acne worse?
Changing hormone levels in adolescent girls
and adult women 2-7 days before their
menstrual period starts
Friction by leaning or rubbing skin
Pressure from helmets, backpacks
Environment: pollution and high humidity
Squeezing or picking at pimples
Hard scrubbing of the skin
Myths about causes of Acne
Foods; chocolate, greasy or fried foods. No
foods cause acne.
Dirt. Acne is not the result of uncleanliness or
infrequent washing.
Stress. Just the opposite, Acne may cause
the patient more stress.
Sunlight or tanning clears acne. No tanning
will lead to sundamaged skin, wrinkles and
skin cancers.
Skin must be scrubbed. No, too much
scrubbing may actually make acne worse.
Who gets Acne?
People of all races and ages.
Most common in adolescents and
young adults
85% between ages 12-25
Resolves with time around age 25-30
Few patients may have persistent acne
into their 40’s and 50’s
Who should be treating Acne?
Family Practice
Pediatrics
Internal Medicine
Dermatology
What are the goals in treating
Acne?
Heal existing lesions
Stop new lesions from forming
Prevent scarring
Minimize the psychological stress and
embarrassment, thus improving self-esteem
and self-confidence and avoiding depression
Teach the patient what acne is, how to treat
their acne and what to expect from treatment
Acne Treatment
Medical treatment is aimed at reducing
several problems that play a role in
causing acne; abnormal clumping of
cells in the follicles, increased oil
production, bacteria and inflammation.
Grading Acne
Scale 0-4
0 – no acne, clear
+1– mild acne, comedos, papules, few
pustules
+2 – moderate acne, comedos, multiple
papules and pustules
+3 – moderately severe, multiple comedos,
papules and pustules, mild scarring
+4 – severe, multiple comedos, papules,
pustules, inflammatory cysts, nodules,
scarring
Treatment for Blackheads,
Whiteheads and mild
inflammatory Acne
OTC or Rx
Benzoyl peroxide, resorcinol, salicyclic
acid and sulfur
Benzoyl peroxide products kill P.acnes
and may reduce oil production
Resorcinol and salicyclic acid and sulfur
help break down blackheads and
whiteheads
OTC Treatment
Benzoyl peroxide washes and gel
Salicyclic Acid washes
Must be used twice daily regularly for 812 weeks, then reevaluate
Treatment of Moderate to Severe
Inflammatory Acne
Prescription topical and or oral
medications alone or in combination
Recheck patient every 4-8 weeks for
results and to adjust acne treatment
program
Treatment of Severe Nodular or
Cystic Acne
Should be seen and treated by a
dermatologist
Failure to respond to a variety of topical
antibiotics, topical retenoids and oral
antibiotics
Consider Accutane Therapy
OTC Topical Acne Cleansers
Neutrogena Acne Wash
Cetaphil Facial Cleanser
Oil of Olay Facial Cleanser
Various Benzoyl Peroxide Cleansers,
Clearsil, Clean and Clear, others
Acne Treatment
Clean skin gently
Avoid squeezing, pinching, picking or
scratching the acne lesions.
Bleeding leads to scarring
Shave carefully
Avoid sunburn or suntan
Choose cosmetics carefully, oil-free,
water based
OTC Acne Topicals
Benzoyl peroxide cleansers
Sulfur products
Salicyclic acid pads
Prescription Acne Cleansers
Benzoyl Peroxide
Brevoxyl 4%, 8%
Triaz 3%, 6%, 10%
Benzac 5%, 10%
Prescription Cleanser
Plexion Cleanser: Sodium
Sulfacetamide 10% & Sulfur 5%
Topical Antibiotics
Clindamycin: Solution,Gel, Lotion, Pads
Erythromycin:Solution,Gel,Pads,
Ointment
Combination: Benzoyl peroxide and
topical antibiotic
Sodium Sulfacetamide and Sulfur
Topical Antibiotics
Cleocin T Solution, Lotion, Gel, Pads
Erycette Pads
Benzamycin Gel
BenzaClin Gel
Klaron Lotion
Plexion SCT
Topical Retenoids
Retin A: gel, cream, microgel
Differin: gel, cream, pad
Generic Tretinoin: gel, cream
Retin A Microgel
0.04% and 0.1%
20gm and 45gm
Apply at hs
Recommend sunscreens in am
Oral Antibiotics
Tetracycline
Minocycline
Doxycycline
Erythromycin
Azithromycin
Oral Tetracycline
Generic Tetracycline is ok
Must be taken correctly, 1 hour before
meal or 2 hours after meal with glass of
water
Not to taken with milk
Increased change of inducing vaginal
yeast infections
Oral Minocycline
Dynacin, Minocin, Adoxa, Generic
Better absorption, less GI upset
May be taken with food, minimal loss of
effect
1-2 times daily
Avoid 100mg bid for it may induce a
blue gray hyperpigmentation in areas of
cysts, bleeding or brusing
Oral Minocycline
Increased cost
Very effective
May be used long term
Oral Doxycycline
Doryx, Generic
Good absorption, less GI upset
May be taken with food, minimal loss
1-2 times daily
Occasional photosensitivity, rare
Increased cost, very effective, may be
used long term
Oral Erythromycin
Eryc 250mg 1 bid
Effective for short times, then bacterial
resistance starts to develop
Low cost, increased GI upset
May have other drug interactions
Oral Azithromycin
Recommend use only by dermatologist
due cost
Accutane (Isotrenoin)
10mg, 20mg, 40mg
Used by itself
Patients must be enrolled into the
SMART Program and rules and
regulations must be followed exactly
Recommend patient be referred to
dermatologist
Accutane (Isotretinoin)
Very effective
Useful to help prevent scarring
15-20 weeks of therapy
SMART Program
Expensive
Patient must be monitored very closely
No other acne treatment needed
Accutane: Disadvantages
Can cause birth defects
Female patients must not get pregnant
while on Accutane
Depression, Irritability
Loss of appetite, hair thinning, curling
Dry eyes, mouth, lips, nose and skin,
itching, nosebleeds, muscle aches,
sensitivity to sun, poor night vision
Accutane: Disadvantages
Changes in blood such as increase in
triglycerides and choesterol or a change
in liver function
Must monitor blood prior to starting and
every 4 weeks while on Accutane
CBC, CMP, Lipid Panel, UA, Urine
pregnancy test
Adjunct Derm Treatment
Acne Surgery
Mild Chemical Peels
Microdermabrasion
New ClearLight treatment
Dermabrasion or Laser tx for scarring
Surgical scar revision
Fillers for scars, fat transfer
Intralesional steroid injections
How often should the Acne
Patient be seen?
Initially every 4-8 weeks
Then every 8-12 weeks
Then every 3-4 months
Acne is monitored and treated for
several years from ages 12-25
Hormonally Influenced Acne
Increased excessive androgen levels in
females may present as hirsutism,
premenstrual acne flares, irregular menstrual
cycles, elevated blood levels of certain
androgens
Birth control pills with increased androgens
will increase acne
Birth control pills with increased estrogens
decrease acne
Recommend OrthoTri-Cyclen or
Demulen
Occasionally but rare use of low dose
corticosteroid drugs, prednisone or
dexamethasone may be used to
suppress the androgen production by
the adrenal gland
Occasional use of spironolactone to
reduce excessive oil production.
Web Sites on Acne
www. aad.org
www.aocd.org
www.niams.nih.gov
www.derm-infonet.com/acnenet