Acneiform Disorders - Types, Causes, & Treatment PDF

Acneiform disorders  acne Acne is a common chronic disorder affecting the hair follicle Acne affects males and females of all races and ethnicities. It is prevalent in adolescents and young adults, with 85% of 16 to 18 year-olds affected. However, it may sometimes occur in children and ad...

Acneiform disorders  acne Acne is a common chronic disorder affecting the hair follicle Acne affects males and females of all races and ethnicities. It is prevalent in adolescents and young adults, with 85% of 16 to 18 year-olds affected. However, it may sometimes occur in children and adults  causes acne? Acne is due to a combination of factors. The exact mechanisms are not fully understood. Familial tendency Endogenous and exogenous androgenic hormones Acne bacteria Innate immune activation with inflammatory mediators Distension and occlusion of the hair follicles  Flares of acne can be provoked by: Polycystic ovarian disease Drugs: steroids, hormones, anticonvulsants, epidermal growth factor receptor inhibitors and others Application of occlusive cosmetics High environmental humidity Diet high in dairy products and high glycaemic foods.  tests are necessary for acne? In most cases, tests are unnecessary. If features are atypical consider: Skin swabs for microscopy and culture Hormonal tests in females. Acne vulgaris Acne vulgaris is the common form of acne, characterised by a mixed eruption of inflammatory and non-inflammatory skin lesions Acne affects both sexes and all races. Although acne mainly affects adolescents, it can affect a wide age range. Infantile acne Acne in children Adult acne  Pathogenesis of acne four important factors: 1-excessive sebum productions 2-hyperkeratinzation of pilosebaceous follicles 3-hyperproliferation of propinobacterium acne (cutibacterium acne) 4-inflammation  clinical features of acne vulgaris? Acne most often affects the face, but it may spread to involve the neck, chest and back, and sometimes even more extensively over the body. Several types of acne spots occur, often at the same time. They may be inflammatory papules, pustules and nodules; or non-inflamed comedones and pseudocysts.  clinical features of acne? Acne is often confined to the face but it may involve the neck, chest, and back. It is characterised by: Open and closed uninflamed comedones (blackheads and whiteheads) Inflamed papules and pustules In severe acne, nodules and pseudocysts Post-inflammatory pigmentation erythematous scars  Severity is classified as mild, moderate, or severe. Mild acne: total lesion count 125  complications of acne vulgaris? Postinflammatory hyperpigmentation Scarring, including keloid scars Psychological effects of acne  treatment for acne vulgaris? Treatment for acne depends on the patient's age and sex , the extent and the severity of the acne, how long it has been present, and response to previous treatments. Treatment for mild acne includes topical anti-acne preparations: Tretinoin, azelaic acid adapaline benzoyl peroxide  Treatment for moderate acne includes antibiotics such as tetracyclines and/or antiandrogens such as birth control pill Treatment for severe acne may require a course of oral isotretinoin.  nodulocystic acne? Nodulocystic acne is a severe form of acne affecting the face and upper trunk, characterised by nodules and cysts that typically resolve with scarring.  Nodulocystic acne is usually a disorder of adolescence and early adult life seen most commonly in males. However there is a rare juvenile form with onset before 6 years of age, also with a male predominance. No studies have shown an increased incidence in specific racial groups. Nodulocystic acne is associated with other follicular occlusion disorders particularly hidradenitis suppurativa.  Specific risk factors for nodulocystic acne include: Genetic factors Drugs including (anabolic steroids, etanercept, imatinib) Dietary supplements such as whey Haemodialysis.  clinical features of nodulocystic acne? Solitary or multiple inflammatory nodules and pseudocysts Firm, fluctuant, and/or tender Involvement of the face, neck, and trunk  acne conglobata? Acne conglobata is a rare severe form of nodulocystic acne. It presents with groups of multiple comedones and inflammatory papules, pustules, and nodules involving the trunk, limbs, and buttocks. Interconnecting abscesses and draining sinuses become secondarily infected causing pain and malodour. Healing is slow, leaving unsightly hypertrophic and atrophic scars. Acne conglobata is often very persistent, lasting into the 30s or 40s.  complications of nodulocystic acne? Psychological effects of acne Keloid, hypertrophic and atrophic scars Pyogenic granuloma  acne diagnosed? Nodulocystic acne is a clinical diagnosis. Hormone studies may be considered in the presence of suggestive clinical features.  treatment for nodulocystic acne? Topical treatment is usually ineffective for nodulocystic acne. The recommended treatment is oral isotretinoin which should be commenced early to prevent scarring. Treatment is required for at least five months, and further courses are sometimes necessary. Intralesional steroids following cyst drainage, can be used for individual persistent or large inflammatory nodules or cysts. Acne fulminans Acne fulminans is a rare and very severe form of acne conglobata associated with systemic symptoms. It nearly always affects adolescent males.  causes acne fulminans? Acne fulminans has been associated with increased androgens (male hormones), autoimmune complex disease and genetic predisposition. It may be related to an explosive hypersensitivity reaction to surface bacteria (Cutibacteria acnes). Acne fulminans may be precipitated by: Testosterone and anabolic steroids (legally prescribed or illegally taken to enhance muscle growth)  clinical features of acne fulminans? Acne fulminans is characterised by: Abrupt onset Inflammatory and ulcerated nodular acne on chest and back, which is painful Bleeding crusts over the ulcers on upper trunk Severe acne scarring Fluctuating fever Painful joints, including sacroiliac joints in 20% of cases, ankles, shoulders, and knee joints Malaise (i.e. the patient feels unwell) Loss of appetite and weight loss Enlarged liver and spleen. Treatment Systemic corticosteroids such as prednisone (20–60 mg/day) Anti-inflammatory medications such as salicylates (aspirin) Dapsone 50–100 mg/d Ciclosporin High doses of oral antibiotics such as erythromycin (2 g/day) for secondary infection Isotretinoin commenced in low dose after control has been obtained with systemic steroids Tumour necrosis factor-alpha (TNF-α) inhibitors, such as infliximab.  causes acne mechanica? Acne mechanica can develop when skin is repeatedly exposed to friction or pressure, such as when wearing certain clothing or sitting in certain positions for long periods of time. The most common underlying causes of acne mechanica include: clothing, such as shirts with collars sports gear, such as football and hockey equipment accessories, such as hats and bras medical equipment, such as casts and surgical tape hands, when rubbing repeatedly against skin seating, such as chairs or car seats  Like acne vulgaris, acne mechanica can cause inflammatory skin lesions, such as papules, pustules, and even nodules. Papules and pustules are the pink and red bumps that many people recognize as “pimples.” Nodules are painful, deep lesions that result from more severe inflammation.  cne mechanica treated? Acne mechanica is treated by first removing the underlying cause of the outbreak. In most cases, this means removing the source of pressure or friction. Benzoyl peroxide. Benzoyl peroxide is a common ingredient in acne treatments because it acts as a deep cleanser to remove dead skin and keep bacteria at bay. Benzoyl peroxide products can vary in strength, so it’s usually recommended to start with lower strength first.  Antibiotics. Topical antibiotics, such as triclosan, may be used in cases where bacteria are suspected to be present with acne mechanica. Topical antibiotics are almost always prescribed with other medications rather than on their own. Vitamins. Topical vitamins, such as retinoids and nicotinamide, can be used to reduce inflammation and promote the growth of new skin. These products are available as both prescription and over-the-counter options. Occupational acne Occupational acne arises from work related condition by physical contact to(halogenated polycyclic hydrocarbons,col tar derivatives ,wood preservatives …..etc) Acne excorie des jeunes filles Acne excorie is a term used to describe scratched or picked pimples. It may also be spelled the French way, acné excoriée. Most people squeeze or pick some of their spots in an attempt to be rid of them. This can makes the acne look worse. The acne may become secondarily infected and picking it may also cause scarring. Some individuals excessively pick their spots. When their skin is examined, they have no active acne spots, only scratch marks, sores, pigmentation and scars. All the inflammatory lesions and comedones have been removed by picking or squeezing. This appearance is called acne excorie.  Anyone who gets acne can suffer from acne excorie. It appears to be more common in females than males, particularly women with late-onset acne. Spending hours in front of the mirror can also be a sign of stress or depression. Psychiatrists may classify acne excorie with body dysmorphic disorder (bodily focused anxiety). Sometimes it is just a bad habit that's hard to break; the acne may not actually be all that severe. In fact there seems to be two subgroups of acne excorie patients – one where patients have primary acne lesions and those who have none or hardly any acne lesions.  treatment for acne excorie? Treatment of acne excorie depends on whether or not the patient has primary acne lesions. Active acne spots can be managed using acne treatment depending on their clinical severity. Some patients with acne excorie may just need to break the habit of picking, whilst other patients may have a compulsive skin picking disorder. This may require psychological therapy and psychotropic drug treatments. Drug induced acne Characteristically, lesions appear after administration of systemic corticosteroid. Topical corticosteroid also can cause. Many medications known to aggravate acne: halogen (iodides, chloorides…) ,antiepleptics ,cilosporin ,lithum , B vitamins Thank you