Acne and Rosacea

1. Acne and Rosacea Dr. D. Czarnecki MD MBBS

2. 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.

3. 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.

4. 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

5. 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

6. Abnormal keratinization bacteria Altered sebum 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.

7. Obstruction Sebum causes inflammation bacteria Altered sebum Sebaceous gland ruptures Obstructed sebaceous dilate and rupture.. The altered sebum causes inflammation in the dermis.

8. Acne • Most patients will clear with: • AnANTI-INFLAMMATORY ANTIBIOTIC • And aCOMEDOLYTIC • 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

9. Acne • Some antibiotics have anti-inflammatory properties. These include: • Tetracycline • Vibramycin • Minomycin • Cotrimoxazole • Erythromycin • The dose must be adequate

10. Acne • COMEDOLYTICS • Remove the obstructions in the sebaceous gland • There are several compounds: • Benzoyl peroxide • Retinoic acid • Azelaeic acid • Adapalene

11. Acne • Other effective therapies are: • ANTI-ANDROGENS • ISOTRETINOIN • Acne does not respond to such things as zinc capsules

12. Acne • Cyproterone acetateis 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.

13. Warn the patient that staining may be left. This will fade overtime.

14. 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

15. Cystic acne – many scars are left where there were cysts

16. Acne • Isotretinoinis 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

17. 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

18. Rosacea • Rosacea looks like acne but it is caused by • leaking blood vessels • Treatment consists of: • ANTI-INFLAMMATORY ANTIBIOTICS • in anADEQUATE DOSEMetronidazole is effective • Topical antibiotics are not very effective • Protection from the sun – UVL aggravates it

19. Acne – sebum in the skin causes inflammation Sebaceous gland ruptures Rosacea – blood vessels leak

20. 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 anADEQUATE DOSE