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Dr Behram
Khan
Associate Professor Dermatology
J.P.M.C
17- 19 yrs
Female 16-17 yrs
PATHOGENESIS
Pilosebaceous
follicle
Pathogenesis:
Acne vulgaris is a disease of
pilosebaceous follicles.
Factors:
Retention hyperkeratosis.
Increased sebum production.
Propionibacterium acnes
Pathogenesis
Sebaceous glands enlarge
Sebum production increases
Growth medium for P. Acnes
plugs provide anaerobic
Lipid-rich environment
Pathogenesis
Bacteria thrive
Inflammation results
Chemotactic factors attract neutrophils
Depending on conditions
Non-inflammatory
open/closed comedones
Inflammatory papule/
pustule/nodule
External factors:
Oils, greases, or dyes in hair products
Cosmetics
water-based products are less comedogenic
Repetitive trauma may worsen inflammation
Soaps decrease sebum but do not alter production
Humidity
perspiration
Sites
Commonly effect face, neck, chest, upper
closed comedo
(a whitehead):
Accumulation of
sebum
converts a
microcomedo into
this.
(a blackhead):
when follicular orifice
is opened + distended.
Cysts
Cysts:
Cysts
Pustular
Comedonal acne
Topical agents:
Isoretinoin (most effective)
Salicylic acid (promotes desquamation)
Azelaic acid (antimicrobial, reduces
hyperpigminetation)
Gycolic acid
Sulfur in OTC rx (keratolytic)
Comedonal acne
Mechanical removal of comedones
useful adjunct to topical rx
pregnancy risk C)
Topical antibiotic (Clindamycin, Erythromycin)
Combination of both (more effective)
oral antibiotics
hormonal rx
Oral isotretinoin
Reduces sebaceous gland size/sebum production
regulates cell proliferation and differentiation
Effect last 1 yr after cessation
Only med altering course of A. Vulgaris
Teratogenic
Increase TG
Bone marrow suppression
Hepatotoxicity
-Tetracycline - erythromycin
- minocycline - TMP-SMX
- doxycycline - clindamycin
HORMONE Rx
Unresponsive acne
Send for Gyn eval if hirsutism/menstrual
irregularities.
Consider adult onset congenital adrenal
hyperplasia, ovarian/adrenal tumour, Cushings dz
/syndrome, PCOS (hirsutism, acne, irregular menses,
acanthosis nigrans, insulin resistance)
estrogen
Min 3-6 mo of rx
Other Therapies
Blue light therapy
Laser therapy