Acne.pdf

Acne Dr. Rand Murshidi Department of Dermatology Jordan university hospital Introduction Acne is a multifactorial disorder of the pilosebaceous unit All age groups may be affected, peak incidence is during adolescence. Psychological impact, social isolation, anxiety, depression even suicidal ideatio...

Acne Dr. Rand Murshidi Department of Dermatology Jordan university hospital Introduction Acne is a multifactorial disorder of the pilosebaceous unit All age groups may be affected, peak incidence is during adolescence. Psychological impact, social isolation, anxiety, depression even suicidal ideation Underlying factors Genetic factors (number , size, activity of sebaceous glands), tendency of severe acne runs in families Dietary factors controversial: Skim milk, whey protein , high glycemic diets, dietary supplements vitamin B12 Androgenic hormones increase size of sebaceous glands and sebum amount Iatrogenic corticosteroid, androgens combined OCP, antiepileptics, EGFR inhibitor Other factors: Fluid retention (premenstrual), stress (inflammation), seasons, , cosmetics(comedogenic) Pilosebaceous unit Pathogenesis Follicular hyperkeratinisation corneocytes normally extruded in acne accumulate , hyperkeratotic plug Hormonal influences on sebum production and composition testesterone and dihydrotestesterone most potent Inflammation in acne Propionibacterium acnes which uses sebum as a substrate. and produces lipases which break down the triglycerides in sebum to form free fatty acids Clinical features Localisation :sites of well developed sebaceous glands. Non-inflammatory vs inflammatory Non-inflammatory : Open vs closed comedones Closed comedone (white heads) small papules , no follicular opening , no erythema Open comedone (black heads) dilated follicular opening with core of shed keratin ( colour due to melanin and lipid oxidation). Inflammatory acne : papules , pustules , nodules, pseudocystes( filled with pus and serosanguinus fluid) may combine to sinus tracts. Variants of acne 1- Acne vulgaris -Acne vulgaris, the common type of acne, occurs during puberty and affects the comedogenic areas of the face, back and chest. There may be a familial tendency to acne. -Acne vulgaris is more common in boys, 30–40% of whom develop acne between the ages of 18 and 19 -In girls, the peak incidence is between 16 and 18 years -Adult acne is a variant affecting 3% of men and 5% of women over the age of 40 2. Infantile Acne Localised acne lesions occur on the face in the first few months of life. Infantile acne may require topical or systemic therapy as although it will resolve spontaneously it may last up to 5 years and can cause scarring. There is an association with severe adolescent acne. Endocrine abnormalities are very rare, but should be considered, especially in a girl with signs of virilism 3. Acne conglobata/fulminans severe form of acne, more common in boys and in tropical climates. There is extensive, nodulocystic acne and abscess formation affecting particularly the trunk, face and limbs Acne fulminans is similarly severe but is associated with systemic symptoms of malaise, fever and joint pains 4. Occupational Acne. 5. Drug Induced Acne. 6. Cosmetic-induced Acne. 7. Acne keloidalis is a type of scarring acne seen particularly on the neck in men 8.Acne excoriée( des jeunes fi lles) is typically seen in teenage girls who present with facial excoriations but very few primary lesions. There are no comedones. This is a form of neurotic excoriation , and patients need to be given a clear explanation and helped to try and reduce the self - inflicted damage. Treatment of acne General measures Full explanation and active therapy are essential. Avoid precipitating factors Cleansers Topica l Systemic treatments Topical treatments Benzoyl peroxide has been available for the treatment of acne for many years; it has bacteriostatic effects against P. acnes and is mildly comedolytic. Salicylic acid promotes desquamation of follicular epithelium and therefore inhibits the formation of comedones Topical retinoids are vitamin A derivatives that are anti inflammatory and comedolytic. Treatments currently available include tretinoin, adapalene Topical antibiotics are effective through their bactericidal activity against P. acnes and consequent anti-inflammatory effects. The most commonly prescribed antibiotics include erythromycin and clindamycin either alone or in combination with other agents such as zinc or benzoyl peroxide. Phototherapy with ultraviolet or visible light is an alternative therapy that may be helpful in those unresponsive to or unable to tolerate conventional treatments. Systemic therapy 1. Oral antibiotics. 2. 3. Hormonal treatments. Oral retinoids. Hormone therapies. These include certain types of OCPs that increase sex hormone-binding globulin and consequently reduce free testosterone levels.These are generally OCPs that have higher oestrogen and lower androgen potential Oral antibiotics Tetracyclines remain the mainstay of treatment in those over the age of 12 years (below this age, they may cause dental hypoplasia and staining of teeth) Tetracyclines should be avoided in pregnancy/breastfeeding and children