ACNE VULGARIS

Dr. Pasid Harlisa, Sp.KK

Bagian Ilmu Kesehatan Kulit dan Kelamin
Fakultas Kedokteran, Universitas Islam Sultan Agung
Semarang ~ 2007
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Acne Vulgaris
Definition : disorder of the pilosebaceous unit
there is large number of keratin mass that expands
to fill the lumen & forms the solid plug in ductus
pilosebaceous.

Clinical finding : there is comedones, papules,

pustules, nodules, cysts
Etiology :
Genetic
Endocrine
Psychis
Food/diet

Seasons
Cosmetical
Injury
etc.

Acne Vulgaris
Patophysiology :
Patiens with acne have

An increased sebum production

Abnormal keratinization
Microorganisms colonisation
Inflammation

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PUBERTY

ANDROGEN HORMONE

SEBUM
PRODUCTION

KERATIN
FORMING

SOLID PLUG IN
DUCTUS
PILOSEBACEOUS

P. ACNES
(LIPASE)

FREE FATTY
ACID

ANDROGEN HORMONE

Classification

By Kligman & Plewig, 1975

Comedonal acne
Papulo-pustules acne
Conglobata acne

By Grupper, 1977

True Acne:

Acne Vulgaris :

Tropical acne
Mechanic acne
Fulminan acne
Neonatal acne

True Acne:

Acne Venenata :

Cosmetical acne

Chlor acne

Occupational acne

Acne Physical :

Senile acne

Radiation acne

Acneiform Eruption Acne like

Diagnosis Base

Anamnesis

Medical History

Age, education, occupancy

Physically depressed
Climate/season
Diet/foods

Physical Examination

Oily skin
Comedonal / non comedonal
Another lesion

Cosmetical
Menstruation
Injury
Drugs

Differential Diagnose

Acneiform eruption
Rosacea
Perioral Dermatitis

Acneiform eruption

Adenoma sebaceous
Molluscum contagiosum
Verucca plana

Initially by inflammation (papulo pustulosa)

Absence of comedones
Usually caused by drugs
Suddenly onset
Affected to wide area
Doesnt match to acne location

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Causative drugs

Iodine
Bromide
INH
Corticosteroid

Vitamin B12
Phenobarbital
Tetracycline

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Therapy
Goal:

To
To
To
To

decrease cebum production

eliminate keratin plug
decrease microorganisms populations
eliminate inflammation

Methods:

Skin care

Therapy

Special Treatment

TOPICAL
TOPICAL&&
SYSTEMIC
SYSTEMIC
COMBINATIO
COMBINATIO
NN

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Using:
Antiseptic
bar
Tonic/cream
cleanser

Sulfur presipitatum
4 10 %
Salicyl Acid 2-5 %
Resorcinol
Alpha Hydroxi acid

SKIN CARE
Removing:
Grime/dust
dead cell
sebum

CLEANS FACE
2 3 TIMES/DAY
Keratolitic
Agent:

TOPICAL
THERAP
Y

Vitamin A acid
0.025-0.1 %
Benzoyl peroxide
2.5-10 %
Azelaic acid 15 %

Antibiotic:
Erythromycin 1-2 % (solution, cream, gel)
Clindamycin HCl/Phosphate 1 % (solution, gel)
Benzoyl peroxide 2.5 10 % (solution, cream, gel)

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Antibiotics

Systemic Therapy
Hormones

Anti androgen
Estrogen
Corticosteroid

Tertracycline
& its derivate
Erythromycin
Clindamycin
Linchomycin

Isotretinoin ( 13 cis retinoic acid )

Combination Therapy

Special Treatment

Topical & Systemic

Comedo Extraction
Triamcinolone acetonede
intra lesion
Dermabration