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ACNE Definition

ACNE Definition. Inflammation of sebaceous follicles Follicle sebaceous gland follicular canal hair. ACNE Classification. comedonal acne mild inflammatory acne moderate inflammatory acne severe inflammatory (nodulocystic). ACNE Pathogenesis. Pubertal changes

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ACNE Definition

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  1. ACNEDefinition • Inflammation of sebaceous follicles • Follicle • sebaceous gland • follicular canal • hair

  2. ACNEClassification • comedonal acne • mild inflammatory acne • moderate inflammatory acne • severe inflammatory (nodulocystic)

  3. ACNEPathogenesis • Pubertal changes • increased sebaceous production of sebum • abnormal sloughing of follicular wall lining • closed comedone (whitehead) • open comedone (blackhead)

  4. ACNEPathogenesis • Accumulation of Propionobacterium acnes (normal skin flora) • metabolization of sebum release of free fatty acids • attraction of neutrophils  rupture of follicular wall extrusion into the dermis • inflammatory lesions • papules, pustules • nodules, cysts

  5. Acnelesions at a glance

  6. ACNELesions Inflammatory and comedonal acne

  7. ACNELesions Open comedones are evident on the chin

  8. ACNELesions inflammatory and comedonal acne

  9. ACNETherapy (Mechanisms) • Hormonal regulation • Sebum suppression • Keratolysis and inhibition of follicular proliferation • Antibacterial / antiinflammatory

  10. Hormonal regulation • Oral contraceptives • particularly estrogen predominant • Ortho-Tri-Cyclen • Spironolactone

  11. Sebum suppression • Isotretinoin (Accutane) • oral synthetic Vitamin A analog • shrinks sebaceous gland

  12. Keratolysis and inhibition of follicular proliferation • OTC preparations • salicylic acid (Stridex) • Benzoyl Peroxide • Isotretinoin (Accutane) • Topical retinoids • tretinoin (Retin-A) • adapalene (Differin) • tazarotene (Tazorac) • Azelaic Acid (Azelex)

  13. ACNETopical retinoids Contemporary Peds Dec. 2000

  14. ACNEAdapalene (Differin) • Derivative of Naphthoic acid • Has more specific retinoid receptor activity • Some studies have shown less irritation

  15. ACNEAzelaic Acid (Azelex) • Dicarboxylic acid produced by P. ovale • demonstrated activity against P. acne • demonstrated ability to inhibit microcomedo • Prevents hyperpigmentation • inhibits tyrosinase (melanin synthesis) • adresses postinflammatory hyperpigmentation

  16. Antibacterial / antiinflammatory • Topical • Erythromycin • Clindamycin • Oral • Tetracycline • Doxycycline • Minocycline • Erythromycin

  17. ACNETopical antibiotics Contemporary Peds Dec. 2000

  18. ACNEOral Antibiotics Contemporary Peds Dec. 2000

  19. Creams Less potent than gels Less drying than gels May not be good for the patient with oily complexion Gels, solutions more drying tend to cause more irritation oily skin ACNEtherapy (vehicle effects efficacy)

  20. ACNECounseling • Poor hygiene is not a cause of acne • Effect of diet has not been demonstrated • 4 – 6 weeks of treatment before any improvement is expected • Warn patients about skin irritation • BP, topical retinoids • Warn patients about photosensitivity • topical retinoids, tetracycline, Doxycycine • apply at night • consider noncomedogenic sunscreen (SPF =15)

  21. ACNECounseling II • Apply topical therapy to entire region not just to lesion • Start at low dose, infrequent applications and increase gradually • Apply to thoroughly dried skin • 30 minutes of air-drying • not right after washing your face • Avoid cosmetics, mechanical friction • harsh scrubbing • tight chin straps, caps • bangs

  22. ACNE Treatment Plans

  23. ACNE Treatment Plans

  24. ACNE Treatment Plans Consultant April 1999

  25. ACNEWhen to refer • No improvement despite therapy • Cysts or scars • sometimes require intralesional steroids • Consideration of Accutane or spironolactone • Associated menstrual irregularity or hirsutism • polycystic ovarian syndrome

  26. ACNE Treatment Plans

  27. ACNE Treatment Plans Contemporary Peds Dec. 2000

  28. ACNE Treatment Plans

  29. ACNE Treatment Plans Contemporary Peds Dec 2000

  30. ACNE Treatment Plans

  31. ACNE Treatment Plans Contemporary Peds Dec 2000

  32. ACNEReferences (required reading) • Pediatric Clinics North America • August 2000 • Contemporary Pediatrics • Dec 2000 • Pediatric Annals • January 2000 Available in the Peds Office

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