ACNE Definition Inflammation of sebaceous follicles Follicle sebaceous gland follicular canal hair
Dec 16, 2015
ACNEClassification
comedonal acne mild inflammatory acne moderate inflammatory acne severe inflammatory (nodulocystic)
ACNEPathogenesis
Pubertal changes increased sebaceous production of sebum abnormal sloughing of follicular wall lining closed comedone (whitehead) open comedone (blackhead)
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
ACNETherapy (Mechanisms)
Hormonal regulation Sebum suppression Keratolysis and inhibition of follicular
proliferation Antibacterial / antiinflammatory
Hormonal regulation
Oral contraceptives particularly estrogen predominant Ortho-Tri-Cyclen
Spironolactone
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)
ACNEAdapalene (Differin)
Derivative of Naphthoic acid Has more specific retinoid receptor
activity Some studies have shown less irritation
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
Antibacterial / antiinflammatory
Topical Erythromycin Clindamycin
Oral Tetracycline Doxycycline Minocycline Erythromycin
ACNEtherapy (vehicle effects efficacy)
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
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)
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
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