Acne and Rosacea Dr. D. Czarnecki MD MBBS. Acne It is a disease of Western societies.It is a disease of Western societies. Young migrants from the Third.

Acne and RosaceaAcne and Rosacea

Dr. D. Czarnecki MD MBBSDr. D. Czarnecki MD MBBS

AcneAcne

• It is a disease of Western societies.It is a disease of Western societies.

• Young migrants from the Third World develop acne Young migrants from the Third World develop acne when they eat the food of their new First World when they eat the food of their new First World homes.homes.

• Acne patients who change their diets improve.Acne patients who change their diets improve.

• Starvation will clear acne.Starvation will clear acne.

AcneAcne

• AndrogensAndrogens cause the sebaceous glands to enlarge cause the sebaceous glands to enlarge and produce sebum. Acne occurs at puberty.and produce sebum. Acne occurs at puberty.

• The Western diet affects insulin secretion.The Western diet affects insulin secretion.• InsulinInsulin has a direct effect on the sebaceous glands has a direct effect on the sebaceous glands

and insulin influences the amount of unbound (free) and insulin influences the amount of unbound (free) testosterone in the serumtestosterone in the serum

• Stress causes the adrenal glands to release more Stress causes the adrenal glands to release more androgens and these aggravate acne.androgens and these aggravate acne.

AcneAcne

• Insulin – causes the sebaceous glands to enlargeInsulin – causes the sebaceous glands to enlarge

• There is an increase in the amount of free There is an increase in the amount of free testosterone because of insulin.testosterone because of insulin.

• The increase in testosterone makes the sebaceous The increase in testosterone makes the sebaceous glands enlarge, block, and rupture.glands enlarge, block, and rupture.

• The contents of the ruptured gland cause The contents of the ruptured gland cause inflammationinflammation

Androgens

Sebaceous gland

Sebum on the skin protects the skin

Sebum

Sebaceous glands enlarge and produce sebum at puberty.

Androgens are the main hormones influencing sebaceous gland metabolism.

Insulin also has an important effect

Cells produce Sebum

Sebaceous gland

Abnormal keratinization

bacteria

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.

Altered sebum

Sebaceous gland ruptures

Obstruction

bacteria

Obstructed sebaceous dilate and rupture..

The altered sebum causes inflammation in the dermis.

Altered sebum

Sebum causes inflammation

AcneAcne

• Most patients will clear with:Most patients will clear with:

• AnAn ANTI-INFLAMMATORY ANTIBIOTICANTI-INFLAMMATORY ANTIBIOTIC• And aAnd a COMEDOLYTICCOMEDOLYTIC

• There is no special facial wash – black heads are There is no special facial wash – black heads are caused by compressed keratin, not by dirtcaused by compressed keratin, not by dirt

• No greasy products on the skin or scalp – these will No greasy products on the skin or scalp – these will be smeared on the face and can obstruct the glandsbe smeared on the face and can obstruct the glands

• Consider the anti-acne diet but it will interfere with a Consider the anti-acne diet but it will interfere with a normal social lifenormal social life

AcneAcne

• Some antibiotics have anti-inflammatory properties. These include:

• Tetracycline• Vibramycin• Minomycin• Cotrimoxazole• Erythromycin

• The dose must be The dose must be adequateadequate

AcneAcne

• COMEDOLYTICS

• Remove the obstructions in the sebaceous gland• There are several compounds:

• Benzoyl peroxideBenzoyl peroxide• Retinoic acidRetinoic acid• Azelaeic acidAzelaeic acid• AdapaleneAdapalene

AcneAcne

• Other effective therapies are:Other effective therapies are:

• ANTI-ANDROGENSANTI-ANDROGENS

• ISOTRETINOINISOTRETINOIN

• Acne does not respond to such things as zinc Acne does not respond to such things as zinc capsulescapsules

AcneAcne

• Cyproterone acetateCyproterone acetate is an anti-androgen

• The dose is 50 mg for 10 days a monthThe dose is 50 mg for 10 days a month• (days 5 to 14 of the cycle)(days 5 to 14 of the cycle)

• The pill should to be taken to keep the The pill should to be taken to keep the • cycle regular. cycle regular.

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

Cystic acne – this is a bad prognostic sign. Most patients Cystic acne – this is a bad prognostic sign. Most patients will have acne for decades and be left with many scarswill have acne for decades and be left with many scars

isotretinoin is the most effective drug for cystic acneisotretinoin is the most effective drug for cystic acne

Cystic acne – many scars are left where there were cystsCystic acne – many scars are left where there were cysts

AcneAcne

• IsotretinoinIsotretinoin is the most effective agent

• The course is for 5 monthsThe course is for 5 months

• The dose should be 1 mg per Kg a dayThe dose should be 1 mg per Kg a day

• The side effects are well toleratedThe side effects are well tolerated

RosaceaRosacea

• A common eruption, A common eruption, more common with agemore common with age

• There is inflammation There is inflammation but no obstruction of but no obstruction of sebaceous glandssebaceous glands

• Papules, pustules, Papules, pustules, diffuse erythema, and diffuse erythema, and possible induration of possible induration of the affected areathe affected area

• No black headsNo black heads

RosaceaRosacea

• Rosacea looks like acne but it is caused byRosacea looks like acne but it is caused by• leaking blood vesselsleaking blood vessels

• Treatment consists of: Treatment consists of:

• ANTI-INFLAMMATORY ANTIBIOTICSANTI-INFLAMMATORY ANTIBIOTICS• in anin an ADEQUATE DOSEADEQUATE DOSE Metronidazole is effectiveMetronidazole is effective

• Topical antibiotics are not very effectiveTopical antibiotics are not very effective

• Protection from the sun – UVL aggravates itProtection from the sun – UVL aggravates it

Sebaceous gland ruptures

Acne – sebum in the skin causes inflammation

Rosacea – blood vessels leak

Rosacea-like eruptionRosacea-like eruption

• Fluorinated steroids used on the face for long Fluorinated steroids used on the face for long periods cause a rosacea like eruption.periods cause a rosacea like eruption.

• Only use 1% hydrocortisone on the face for long Only use 1% hydrocortisone on the face for long periods.periods.

• Treatment – Treatment –

• ANTI-INFLAMMATORY ANTIBIOTICSANTI-INFLAMMATORY ANTIBIOTICS• in anin an ADEQUATE DOSEADEQUATE DOSE