ACNE

VULGARIS
Acne vulgaris (AV) is a self
limiting disease, seen
primarily in adolescents
involving the sebaceous
follicles.
May be present at birth or
first 6 months of life.
In girls, the occurrence of
acne may precede
menarche (14 16 years).
Boys tend to have a peak
incidence between ages 16 &
19 years.
Nodulocystic acne to be more
common in while males than
in black males.
Acne is more severe in
patient with xyy genotype
Basic cause of acne in
unknown.
Acne is a multifactorial
disease.
Four principal pathologic in
acne are :
1. Abnormal follicular
keratinization.
2. Increased sebum production.
3. Proliferation of
Propionibacterium acnes in
the sebum.
4. Inflammation.
Androgen are known to
regulate the development of
the sebaceous gland & sebum
production.
Patient with acne may have
increased levels of circulating
androgens.
Stress is known to increase
the output of adrenal steroids,
which may affect the
sebaceous glands.
Primary site face, upper
back, chest, shoulder.
Lesion may be non
inflammatory or inflammatory.
Non-inflammatory lesion
comedones :
Open (blackheads).
Closed (whiteheads).
Open comedo a flat or
slightly raised lesion with a
central dark colored
follicular impaction of
keratin & lipid.
Closed comedo pale,
slightly elevated, small
papules & do not have a
clinically visible orifice.
Inflammatory lesions vary
from small papules with an
inflammatory areola to
pustules to large, fluctuant
nodules.
Large nodules
nodulocystic (severe cases
of inflammatory acne).
Patient may have scars of
varying size a sharply
punched out pit.
Finding of mixture of
lesions of acne :
Comedones.
Pustules.
Papules.
Nodules on the face.
Back.
Chest.
Folliculitis.
Rosasea.
Perioral dermatitis.
1. Topical therapy :
Tretinoin :
Cream : 0,025%, 0,05%,
0,1%.
Gel : 0,01%, 0,025%.
Liquid : 0,05%.
Benzoyl peroxide : lotion,
creams, gels, washes
(2,5%, 5%, 10%
concentrations).
Topical antibiotics :
Clindamycin : gel, lotion,
solution (1%).
Erythromycin in 1 2%
solution, ointment.
Azelaic acid : cream 20%.
Cleaning agents.
Astringents.
2. Physical therapy :
Cryoslush therapy.
Ultraviolet light.
Radiation therapy.
Acne surgery.
Intralesional corticosteroid
: 0,05 0,25 ml per lesion
(triamcinolone acetate).
3. Systemic therapy :
Antibiotic :
Tetracycline : 500 1000
mg/d for 4 5 weeks.
Dose can be reduced to a
maintenance level of 250
500 mg/d for several
months.
Minocycline : 50 100 mg
once ro twice daily.
Doxycycline : 50 mg twice
daily, severe cases 100 mg
twice daily.
Sulfonamide.
Hormonal therapy :
Estrogens : ethynil
estradiol 0,035 0,050 mg.
Oral contraceptives.
Glucocorticoids.
Gonadotropin-releasing
hormon agonists.
Antiandrogen.
Retinoids :
Recommended dose 0.5
2 mg/kg for 15 20
weeks.
Favorable with spontaneous
resolution.
Physical sequela : scar
special cure (peeling and
dermabration).