0 Occlusion of
0 Increased sebum
0 Microbial colonization.
0 Release of
OCCLUSION OF PILOSEBACEOUS
Occluded by keratinous plug induced by chemicals and
reduced level of linoleic acid in sebum
Retention of sebum encouraging growth of microbes.
Distended follicle rupture, releasing proinflammatory
chemicals into dermis
0Occurs due to end organ sensitivity to androgens.
Increased activity of 5α reductase in sebaceous
Converts testosterone to 5 α testosterone
Binds to receptors in sebaceous gland
Increase sebaceous secetion.
0 PREVELANCE -affects all adolescents.
Both sexes equally but nodulocystic acne common in
1. GENETIC PREDISPOSITION
Found to be familial
Identical twins shows greater concordance of severity of acne.
High glycemic diet.
Seen in women using oil based cosmetics for long time.
Follows facial massage.
4. MENSTRUAL CYCLE
Premenstrual edema of pilosebaceous duct.
5. PSYCHOLOGICAL FACTORS
0 Polymorphic eruption consisting of
papules, pustules, nodules, cysts, and pathognomic
open and closed comedones on a background of
0 Hyperkeratotic plug made of sebum and keratin in
0 Pathognomic lesions of acne vulgaris.
0 2 types:
1. Open comedones.
2. Closed comedones.
0 Also known as Black head.
0 Due to plugging of pilosebaceous orifice by keratin
and sebum on the skin surface.
0 Due to keratin and sebum accretions plugging the
pilosebaceous ducts below the skin surface.
0 SUBMARINE COMEDONES-deep seated and seen by
stretching the skin.
Grades of Acne (Pillsburry’s
Grade I: Comedones (open or closed), occasionally
pustules or papules; no scarring.
Grade II: papules, comedones, few pustules; mild scarring.
Grade III: predominant pustules, nodules, abscesses;
Grade IV: mainly cysts, abscesses, scars; severe scarring.
0 Acne scars can be:
1. Ice pick scars- deep pits.
2. Box car scars-superficial/deep
3. Rolling scars
Hypertrophic and keloidal scars.
0 Severe form of acne characterised by
intercommunicating abscess, cysts, and sinuses
loaded with serosanguinous fluid or pus.
0 Multiporous comedones.
0 Lesions take months to heal and on healing leave
behind deep pitted or hypertrophic scars.
0 Caused by exposure to industrial chemicals
(tar, chlorinated hydrocarbons) and cutting oils.
0 Predominantly comedones
0 Seen in women using cosmetics(oil based ones)
0 Frequently on the chin
DRUG INDUCED ACNE
0 Steroids, androgens, oral
drugs, iodides, bromides and anticonvulsants.
0 Lesions are monomorphic, consisting of papules and
0 Site- trunk especially back.
0 Due to presence of maternal hormones in child.
0 Common in males.
LATE ONSET ACNE
0 Onset after 25 years of age.
0 Predominantly women.
0 Deep seated persistent lesions on lower half of face.
0 Seen in young girls, who obsessively pick their mild
0 Results in discrete excoriations on face, while
comedones, and papules are few and far between.
0 Acute onset.
0 Crusted ulcerated lesions.
0 Associated with fever, myalgia and arthralgia.
ACNE AFTER FACIAL
0 3-6 weeks later as acneiform eruption.
0 Indolent deep seated nodules with vey few
0 Predominantly on cheeks along the mandible.
0 Acne scarring may be mistaken for acne
keloidalis, varioliform, atrophy and porphyria cutanea
1. Local hygiene
Regular cleansing with soap and water and avoiding
use of oil based cosmetics.
Avoid use of high glycemic diet.
Most frequently used agent in acne.
Effective against comedones and inflammatory acne.
Reduces formation of microcomedo.
Side effects include irritation and photosensitivity.
0 Benzoyl peroxide
Powerful antimicrobial which decrease population of
Used in both inflammatory acne and non inflammatory
Side effects include irritation and bleaching of hair.
0 Topical antibiotics
Clindamycin(1-2%) and erythromycin(2-4%)
Used in inflammatory acne since it suppress P.acnes.
Side effect: antibiotic resistance. So should be
combined with retinoids or benzoyl peroxide.
Mostly Doxycycline and minocycline; Erythromycin and
Inhibit growth of P.acnes and has direct anti
Doxycycline - onycholysis, oesophagitis with
ulceration, fixed drug eruptions, photosensitivity etc.
Minocycline - benign intracranial hypertension,
pappiloedema, blue-black pigmentation and rarely
Macrolide group - gastritis, diarrhoea.
0 Act by decreasing sebum secretion rate.
0 Used only in females with late onset acne and