Acne

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Acne

  1. 1. <ul><li>Dr. Vidyanand Tannu (Consultant Dermatologist & Cosmetologist In Pune) </li></ul><ul><li>Contact : 9823130197 </li></ul><ul><li>Email : [email_address] </li></ul><ul><li>Website: www.komalclinic.co.in </li></ul>
  2. 2. <ul><li>One of the most common skin diseases presenting to family physicians </li></ul><ul><li>Considerable psychological impact on the quality of life </li></ul>
  3. 3. Definition Definition Acne is an inflammatory diorder of pilosebaceous unit and is the commonest dermatological problem of the teenage group .
  4. 4. Anatomy of skin
  5. 5. <ul><li>Four important factors </li></ul><ul><ul><li>Plugging of the hair follicle </li></ul></ul><ul><ul><li>Hyperactivity of the sebaceous gland </li></ul></ul><ul><ul><li>Proliferation of Propionobacterium Acnes </li></ul></ul><ul><ul><li>Inflammation </li></ul></ul>Pathophysiology
  6. 6. Different Grades <ul><li>Grade I : Comedones ( Closed , Open ) </li></ul><ul><li>Mild </li></ul><ul><li>Grade II : Comedones , Papules , Superficial Pustules </li></ul><ul><li>Moderate </li></ul><ul><li>Grade III : Comedones , Papules , Deeper Pustules </li></ul><ul><li>Moderate-Severe </li></ul><ul><li>Grade IV : Nodules , Cysts , Sinuses & Scars </li></ul><ul><li>Severe </li></ul>
  7. 7. Stages of Development
  8. 8. Grade I Closed ( Whitehead ) and Open ( blackheads )
  9. 9. Grade I Closed comedones (whiteheads) <ul><li>Closed Comedo </li></ul><ul><li>(a whitehead): Accumulation of sebum converts a microcomedo into this. </li></ul>
  10. 10. Grade I Open Comedo (blackhead) <ul><li>Open Comedo </li></ul><ul><li>( Blackhead): when follicular orifice is opened + distended. </li></ul><ul><li>Melanin + packed keratinocytes + oxidized lipids  dark colour </li></ul>
  11. 11. Grade II <ul><li>Grade II Acne : Characterized by mainly open and closed comedones ( black heads and whiteheads) and papules, with some </li></ul><ul><li>pustules.  Papules are small, granular lesions associated with the destruction of the epithelial lining of the sebaceous hair follicle wall.  These may be inflammatory and scarring generally does not result. </li></ul>
  12. 12. Grade III Grade III Acne : Characterized by papules and pustules.  Pustules have yellowish, blister-like appearance and result from the breakdown of the follicle wall.  Nodules are small, solid nodes detectable by touch.   Scarring may be likely .
  13. 13. Grade IV Grade IV Acne : Characterized by a few comedones, some papules, and many pustules, nodules, cysts and abcesses.  This is a severe but not very common form of acne known as acne conglobata.  Scarring exists and is generally severe. .
  14. 14. GRADE IV NODULYSTIC ACNE
  15. 15. Neonatal Acne <ul><ul><li>First four weeks of life </li></ul></ul><ul><ul><li>Develops a few days after birth . </li></ul></ul><ul><ul><li>Facial papules or pustules . </li></ul></ul>
  16. 16. Infantile Acne <ul><ul><li>Cases that persist beyond 4 weeks or have an onset after . </li></ul></ul><ul><ul><li>R/O acne cosmetic ,acne venenata ,drug induced acne </li></ul></ul>
  17. 17. <ul><ul><li>Conglobate : Shaped in rounded mass or ball </li></ul></ul><ul><ul><li>Severe form of acne characterised by numerous comedones , large abscesses with sinuses, grouped inflammatory nodules . </li></ul></ul><ul><ul><li>Suppuration </li></ul></ul><ul><ul><li>Cyst on forehead , cheeks & neck . </li></ul></ul>Acne Conglobata
  18. 18. <ul><ul><li>Rare form of extremely severe systic acne . </li></ul></ul><ul><ul><li>Teenage boys chest and back </li></ul></ul><ul><ul><li>Rapid degeneration of nodules leaving ulceration . </li></ul></ul><ul><ul><li>Fever leukocytosis arthralgias are common . </li></ul></ul>Acne Fulminans
  19. 19. <ul><ul><li>Disorder characterized by a sudden fulminating onset of purulent nodulocystic lesions localized to the face with superficial or deep abscesses. It mainly affects women in their twenties </li></ul></ul>Pyoderma Faciale
  20. 20. <ul><ul><li>It is an inflammation or bacterial infection of the hair on the scalp. The infection can be shallow or deep depending on the extent of disease and can even lead to formation of inflammatory bump which will surround the hair. A furuncle or a boil is formed when folliculitis is of the sebaceous gland. Another deeper version of a furuncle is a carbuncle which is actually formed deep within and has many sinuses. Mostly it affects the scalp hair follicles but can easily spread to other skin areas like, the bearded area of the face in men, chest, armpits, buttocks, groin and thighs . </li></ul></ul>Folliculitis Gram-negative folliculitis pictures Scalp folliculitis
  21. 21. <ul><li>Histroy Concominant Illness </li></ul><ul><li>Age Physical Examination </li></ul><ul><li>Motivation Skin Type </li></ul><ul><li>Life Style / Hobbies Skin Colour </li></ul><ul><li>Occupation Lesion Morphology </li></ul><ul><li>Previous Treatment Comedones </li></ul><ul><li>Cosmetic Usage Inflammatory Papules </li></ul><ul><li>Mentrual History Pustules </li></ul><ul><li>Medications Cysts </li></ul><ul><li>Oral Contraceptives Scarring </li></ul><ul><li>Anabolic Steriods Pitted </li></ul><ul><li>Corticosteriods Hpertrophic </li></ul><ul><li>Postinflammatory pigmentry Atrophic </li></ul><ul><li>changes </li></ul>Patients Diagnosis History and Physical Examination of the Patients
  22. 22. Management <ul><li>Patient Education </li></ul><ul><ul><li>washing of lesions </li></ul></ul><ul><ul><li>picking lesions </li></ul></ul><ul><ul><li>premenstrual flare </li></ul></ul><ul><ul><li>hair care products </li></ul></ul>
  23. 23. Management <ul><li>Patient Education </li></ul><ul><ul><li>improvement is not overnight </li></ul></ul><ul><ul><li>treatment must be used regularly </li></ul></ul><ul><ul><li>treatment is long term </li></ul></ul>
  24. 24. Management <ul><li>Topical Therapy (Indications) </li></ul><ul><ul><li>comedonal acne </li></ul></ul><ul><ul><li>mild to moderate inflammatory acne </li></ul></ul>
  25. 25. Management <ul><li>Topical Therapy (Basic Rules) </li></ul><ul><ul><li>Avoid applying medication right after </li></ul></ul><ul><ul><li>washing face </li></ul></ul><ul><ul><li>Avoid over use of medication </li></ul></ul><ul><ul><li>Apply on all acne prone areas </li></ul></ul><ul><ul><li>If face gets dry apply oil free moisturizer </li></ul></ul>
  26. 26. Management <ul><li>Topical Therapy (Treatment Vehicle) </li></ul><ul><ul><li>cream  sensitive or dry skin </li></ul></ul><ul><ul><li>lotion  any skin type </li></ul></ul><ul><ul><li>gel  oily skin </li></ul></ul><ul><ul><li>solution  oily skin </li></ul></ul>
  27. 27. Management <ul><li>Topical Therapy (Anti Comedonal Agents) </li></ul><ul><ul><li>Topical Retinoids </li></ul></ul><ul><ul><li>Azelaic acid </li></ul></ul><ul><ul><li>Salicylic acid </li></ul></ul>
  28. 28. Management <ul><li>Topical Retinoids 0.025% - 0.5% (application) </li></ul><ul><ul><li>Apply at night </li></ul></ul><ul><ul><li>always apply test dose </li></ul></ul><ul><ul><li>start at low concentrations </li></ul></ul><ul><ul><li>avoid in pregnancy </li></ul></ul>
  29. 29. Management <ul><li>Topical Retinoids 0.025% - 0.1% (side effects) </li></ul><ul><ul><li>pustular flare </li></ul></ul><ul><ul><li>photosensitivity </li></ul></ul><ul><ul><li>skin irritation and erythema </li></ul></ul><ul><ul><li>dryness and peeling </li></ul></ul>
  30. 30. Management <ul><li>Azelaic Acid 20% </li></ul><ul><li>(application and side effects) </li></ul><ul><ul><li>applied twice daily </li></ul></ul><ul><ul><li>erythema and irritation </li></ul></ul><ul><ul><li>decrease in pigmentation </li></ul></ul>
  31. 31. Management <ul><li>Salicylic Acid 0.5 - 2% </li></ul><ul><li>(application and side effects) </li></ul><ul><ul><li>applied twice daily </li></ul></ul><ul><ul><li>skin dryness and irritation </li></ul></ul>
  32. 32. Management <ul><li>Topical Therapy (Anti Inflammatory Agents) </li></ul><ul><ul><li>Benzoyl Peroxide </li></ul></ul><ul><ul><li>Topical antibiotics </li></ul></ul>
  33. 33. Management <ul><li>Benzoyl Peroxide 2.5 - 10% </li></ul><ul><li>(application and side effects) </li></ul><ul><ul><li>apply once to twice daily </li></ul></ul><ul><ul><li>always apply test dose </li></ul></ul><ul><ul><li>dryness of skin </li></ul></ul>
  34. 34. Management <ul><li>Topical Antibiotics, Clindamycin and Erythromycin,Clarithromycin, </li></ul><ul><li>Nadifloxacin ( Nadibact 10 cream ), (application and side effects) </li></ul><ul><ul><li>apply twice daily </li></ul></ul><ul><ul><li>skin dryness </li></ul></ul>
  35. 35. Nadibact Cream ( Nadifloxacin 1% w/w ) Nadifloxacin : Clinical Indaication And Dosage <ul><ul><li>- Bacterial skin infection </li></ul></ul><ul><ul><ul><li>Twice daily for 1 to 2 weeks </li></ul></ul></ul><ul><ul><li>Acne vulgaris </li></ul></ul><ul><ul><ul><li>-Twice daily for a maximum period of 6 months </li></ul></ul></ul>Face to face with life
  36. 36. Management <ul><li>Systemic therapy (Indications) </li></ul><ul><ul><li>moderate inflammatory acne non responsive to topical therapy </li></ul></ul><ul><ul><li>nodulocystic acne </li></ul></ul>
  37. 37. Management <ul><li>Systemic therapy </li></ul><ul><ul><li>Oral Antibiotics </li></ul></ul><ul><ul><li>Isotretinoin </li></ul></ul><ul><ul><li>Hormonal Therapy </li></ul></ul>
  38. 38. Management <ul><li>Oral Antibiotics </li></ul><ul><ul><li>Tetracycline </li></ul></ul><ul><ul><li>Doxycycline </li></ul></ul><ul><ul><li>Minocycline ( Divaine 50/100 cipla ) </li></ul></ul><ul><ul><li>Eythromycin </li></ul></ul><ul><ul><li>Azithromycin ( Azipro 250/500 cipla ) </li></ul></ul><ul><ul><li>Combined with topical therapy </li></ul></ul>
  39. 39. Management <ul><li>Isotretinoin indicated in </li></ul><ul><ul><li>severe nodulocystic acne </li></ul></ul><ul><ul><li>non responsive acne </li></ul></ul><ul><ul><li>severe psychological distress </li></ul></ul><ul><li>Only to be used by physicians with experience in the therapy of severe dermatological disorders </li></ul>
  40. 40. Management <ul><li>Isotretnoin side effects </li></ul><ul><ul><li>teratogenic </li></ul></ul><ul><ul><li>mucosal dryness </li></ul></ul><ul><ul><li>photosensitivity </li></ul></ul><ul><ul><li>arthralgias </li></ul></ul><ul><ul><li>alteration of liver enzymes </li></ul></ul><ul><ul><li>hypertriglyceridemia and hypercholesterolemia </li></ul></ul>
  41. 41. Management <ul><li>Hormonal Therapy indicated in </li></ul><ul><ul><li>acne associated with hirsutism, menstrual irregularity and alopecia </li></ul></ul><ul><ul><li>women desiring contraception </li></ul></ul>
  42. 42. Management <ul><li>Hormonal Therapy </li></ul><ul><ul><li>Oral contraceptives containing low androgenic progesterone </li></ul></ul><ul><ul><li>Cyproterone Acetate </li></ul></ul><ul><ul><li>Spironolactone </li></ul></ul><ul><ul><li>Ethylene Estreriodal </li></ul></ul><ul><ul><li>Drosperinone </li></ul></ul>
  43. 43. Acne Keloidalis <ul><li>Folliculitis of the deep levels of the hair follicle that progresses into a perifolliculitis </li></ul><ul><li>Occurs at nuchal area in blacks or Asian men </li></ul><ul><li>Not associated with acne vulgaris </li></ul><ul><li>Hypertrophic connective tissue becomes sclerotic, free hairs trapped in the dermis contribute to inflammation . </li></ul>
  44. 44. Acne Vs Rosacea
  45. 45. Rosacea <ul><ul><li>Chronic inflammatory eruption of the flash . </li></ul></ul><ul><ul><li>Erythema,papules,pustules, </li></ul></ul><ul><ul><li>Telangectasia,hpertrophy of sabeceous glands . </li></ul></ul><ul><ul><li>Usually mild face . </li></ul></ul><ul><ul><li>Women ages 30-50 </li></ul></ul>
  46. 46. Rosacea
  47. 47. Ocular Rosacea <ul><li>Blepharitis , Conjuctivitis </li></ul><ul><li>Keratitis , iritis , episcleritis </li></ul><ul><li>C/O gritty , stinging sensation . </li></ul><ul><li>Ocular Rosacea ocuurs in 58 % of rosacea patients . </li></ul>
  48. 48. Rosacea Etilogy <ul><li>Vasomotor Liability </li></ul><ul><li>Hot Liquids, steriods ( oral and topical ) perioral dermatitis . </li></ul><ul><li>Demodex folliculorum not causative . </li></ul>
  49. 49. Rosacea <ul><li>Differential Diagnosis Rosacea </li></ul><ul><ul><li>Acne Vulgaris </li></ul></ul><ul><ul><li>Lupus Erythematosus </li></ul></ul><ul><ul><li>Bromoderma ioderma </li></ul></ul><ul><ul><li>Papular syphilid </li></ul></ul>
  50. 50. Rosacea Treatment <ul><ul><li>Long term tetracycline is suppresive , </li></ul></ul><ul><ul><li>required for ocular rosacea . </li></ul></ul><ul><ul><li>Topical Metronidazole </li></ul></ul><ul><ul><li>Sunscreen avoidance of flushing triggers </li></ul></ul><ul><ul><li>Flash Lamped pumped dye lasers for </li></ul></ul><ul><ul><li>telangectasias . </li></ul></ul>
  51. 51. Cosmetic Treatment Skin Rejuvination REJUVENATION - IMPROVEMENT IN YOUR LOOK SOFTENING WRINKLES PIGMENT STAINS AND OTHER SIGNS OF AGEING MECH. OF ACTION- THERMAL DISTURBANCE OF SKIN COLLAGEN RESULT IN 1. ACTIVATION OF HEALING PROCESS 2. STIMULATION OF CELL ACTIVITY 3. FORMATION OF NEW COLLAGEN
  52. 52. MICRODERMABRASION RADIO FREQUENCY PHOTOREJUVANATION DERMA ROLLER CHEMICAL PEELING LASER RESURFACING BOTOX Skin Rejuvination Methods
  53. 53. Skin Rejuvination Microdermabrasion Clinical Indication : Acne , Acne Scars , Wrinkles , Fine Lines , Rejuvination of Healthy Skin , Age Spots , Hperpigmentation , Stretch Marks, Pores , Photodamaged Skin . DURATION : 4-6 Sittings at interval of 5-10 days . COMPLICATION : Erythema , Burning during the procedure , dryness .
  54. 54. Microdermabrasion Before After
  55. 55. Skin Rejuvination RADIO FREQUENCY INDICATION WARTS MOLES LENTIGENS ACROCORDON ADVANTAGE MINIMAL SCARRING, POST INFLAMATORY HYPERPIGMENTATION DUE TO HYDRODESSICATION METHOD.
  56. 56. RADIO FREQUENCY Before After
  57. 57. Skin Rejuvination PHOTOREJUVANATION <ul><li>METHOD INTENSE PULSE LIGHT </li></ul><ul><li>MECHANISM THERMAL DISTURBANCE OF COLLAGEN </li></ul><ul><li>SITTINGS 4 TO 6 AT INTERVAL OF 15 DAYS TO 3 WEEKS </li></ul><ul><li>INDICATIONS PHOTODAMAGE FACE </li></ul><ul><li>FINE WRINKLES </li></ul><ul><li>SPOTS </li></ul>
  58. 58. Skin Rejuvination PHOTO-REJUVANATION Before After
  59. 59. Skin Rejuvination Dermaroller INDICATION & ADVANTAGE : Facial Aging. Fine wrinkles around the eyes, lower eyelids, forehead and upper lips. Photodamaged skin with pigmentation. Acne scarring. Reducing stretch marks and tightening loose skin after childbirth. Laxity of skin in the arms and tummy after liposuction and Thermage. Accelerate transdermal penetration of medically recommended topical cosmeceuticals. Scars following accidents and burns.
  60. 60. Skin Rejuvination DERMAROLLER Before After
  61. 61. Skin Rejuvination Chemical Peeling <ul><li>CHEMICAL AGENT OF A DEFINE STRENGTH IS APPLIED TO THE SKIN WHICH CAUSES CONTROL DESTRUCTION OF LAYERS OF SKIN THAT IS FOLLOWED BY REGENERATION AND REMODELING. </li></ul><ul><li>VARIOUS AGENT : </li></ul><ul><li>ALPHA HYDROXY ACID </li></ul><ul><li>SALICYLIC ACID </li></ul><ul><li>TRICHLOROACETIC ACID </li></ul><ul><li>MANDELIC ACID </li></ul><ul><li>PHENOL 88% ETC </li></ul><ul><li>Clinical Indications : Fine wrinkles , Uneven Pigmentation , Aging , Photodamaged skin </li></ul>
  62. 62. Skin Rejuvination Chemical Peel Before After
  63. 63. Skin Rejuvination LASER LASER TYPE INDICATIONS 1.long-Pulsed Ruby 2.Alexandrite lasers 3.ND:Yag Hair Removal 1.Pulsed CO2 Laser 2.Erbium : Yag Laser Facial Wrinkles , Scars & Photodamaged Skin Pulse Dye Laser Vascular Lesions 1.Black: QS ruby, alexandrite or Nd:YAG . 2.Blue and green: QS ruby, alexandrite . 3.Yellow, orange, red: QS Nd:YAG or PDL Pigmented Lesion & Tattoos
  64. 64. BEFORE AFTER Laser Hair Removal
  65. 65. BEFORE AFTER Laser in scars,photodamaged skin
  66. 66. <ul><li>Dr. Vidyanand Tannu (Consultant Dermatologist & Cosmetologist In Pune) </li></ul><ul><li>Contact : 9823130197 </li></ul><ul><li>Email : [email_address] </li></ul><ul><li>Website: www.komalclinic.co.in </li></ul>
  67. 67. Thank You

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