Top Banner
Precious Teens Precious Lives Presidential Action Plan 2018-19 Acne in Adolescents
17

Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Jul 28, 2020

Download

Documents

dariahiddleston
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne in Adolescents

Page 2: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Objectives

• To discuss pathophysiology of acne

• To outline management of adolescent acne

Page 3: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Epidemiology and Importance

• 90% of adolescents , all races , both sexes• Family history is often positive • Typically presents at 12-14 , peaks at 15-18, and

resolves by age 25• Face, neck and upper trunk • Menstrual acne 7-10 days before onset of periods ;

stops with onset• Acne –low body image-low self esteem – depression-

anxiety – social phobia - significant negative psychological effect -suicide

Page 4: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Page 5: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Case Gulnaz , 15-year-old teenager presents with “pimples” on her face for the last 2 years. She has a daily routine of aggressive facial cleansing with a bar soap during her morning shower.

• Past History: No chronic illnesses / hospitalisation

• Allergies: None • Medications: None • Family history: Both parents had acne

as teens • Social history: High school student

Any other history ?

Page 6: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

HEEADSSS

• Home: lives with parents , both parents had

acne as teenagers

• Education: High school student

• Eating: Eats a balanced diet

• Activities: Avoids moving out

with friends

• Drugs: No smoking / alcohol/ drugs

• Sex: Never been sexually active

• Suicide: No history of depression

Page 7: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne Classification

How do we grade acne ?

Page 8: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Grades of Acne

Grade I: Comedones (open or closed), occasionally pustules or papules (10); no scarring.

Grade II: comedones, Papules, few pustules (10-40); mild scarring.

Grade III: Predominant pustules (40-100), nodules, abscesses; moderate scarring.

Grade IV: Mainly cysts, abscesses, scars; severe scarring.

Page 9: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Pathogenesis of Acne

Breaks sebum to highly irritating free fatty acids

Inflammation

Inflammatory acne -lipase

Obstructing plug prevents sebum reaching the skin surface

P. acnes colonizes the pilosebaceous duct

Increased level of circulating androgens Stimulation of sebum production

Page 10: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Anatomy and Physiology of skin Microcomedone

Closed comedone (whitehead) Open comedone (blackhead)

Page 11: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne with Hirsutism and Alopecia

What would you consider as differential diagnosis ?

Page 12: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Treatment

• Diet

• Skin care

• Topical Therapy

• Systemic Therapy

• Laser and cosmetic therapy

• Counselling

Page 13: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Skin CareBasic skin care

No vigorous washing, scrubbing or picking

Cleanse with a gentle soap containing salicylic acid, glycolic acid or benzoyl peroxide

Use noncomedogenic moisturiser, if needed

Based on skin type, choose appropriate vehicle for topical treatments Oily (solutions, gels, pledgets , no moisturizers)

Combination (lotions)

Dry (cream, ointment)

Page 14: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Topical Therapy

• Benzoyl peroxide

• Azaleic acid

• Salicylic acid and alphahydroxy acids

• Retinoids (Adapalene)

• Topical antibiotics : Clindamycin(1-2%) and erythromycin(2-4%)

Page 15: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Systemic Treatment

Systemic treatments : when topicals as monotherapy are ineffective

First Line:

Doxycycline 50 mg daily /Minocycline 50 mg BD

Second Line :

Erythromycin 250-400 mg once or twice daily

Azithromycin 500 mg

Clarithromycin 250 mg

TMS 80-400 mg once or twice daily

Combined Oral Contraceptives

Page 16: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

Key Messages

• Acne is commonly seen in adolescence

• Acne occurs due to excessive proliferation of follicular keratinocytes because of increased levels of circulating androgen

• Psychological effects of acne should be assessed and managed carefully in each case

• The treatment includes: Topical Therapy , Systemic Therapy , Skin care , Balanced diet

Page 17: Acne in Adolescents · Acne in Adolescents. Presidential Action Plan 2018-19 Precious Teens Precious Lives Objectives •To discuss pathophysiology of acne •To outline management

Precious Teens Precious LivesPresidential Action Plan 2018-19

ContributorsMission Kishore Uday 2018-19

• Dr Preeti M Galagali

• Dr Atul M Kanikar

• Dr Sushma P Desai

• Dr Chitra Dinakar

• Dr Latha R

• Dr Sandip K Trivedi

• Dr Harmesh S Bains

• Dr Somashekar AR

• Dr Sarala Premkumar

• Dr Poongodi Bala