Acne vulgaris ( skin disorder)

2. Acne vulgaris is the most common
cutaneous disorder in the U.S.
It affects more than 17 million Americans.
 It is a chronic condition affecting more
than 85% of adolescents and young
adults.

3. Acne, also known as acne vulgaris, is a
long-term skin disease that occurs
when hair follicles are clogged with dead
skin cells and oil from the skin.

4.  It primarily affects areas of the skin with a
relatively high number of oil glands,
including the face, upper part of the chest,
and back.

5.  It is characterized by blackheads or
whiteheads, pimples, oily skin, and
possible scarring.

7. A skin condition that occurs when hair
follicles plug with oil and dead skin cells.
Multi-factorial disease characterized by
abnormalities in sebum production,
follicular desquamation, bacterial
proliferation and inflammation.

8. 85% adolescents experience it.
Prevalence of comedones (lesions) in
adolescents approaches 100%
 Estimated that 200-300 million acne
sufferers from India.
 More common in females than males

9. Acne vulgaris is a diseaseAcne vulgaris is a disease
of pilosebaceous follicles.of pilosebaceous follicles.
Factors:Factors:
 Retention hyperkeratosis.Retention hyperkeratosis.
 Increased sebumIncreased sebum
production.production.
 Propionibacterium acnesPropionibacterium acnes
within the follicle.within the follicle.
 InflammationInflammation

10. ACNEACNE
VULGARISVULGARIS
NONNON
INFLAMMATORYINFLAMMATORY
INFLAMMATORINFLAMMATOR
YY

11.  Non-inflammatory acne includes
blackheads and whiteheads. These
normally don’t cause swelling.

12.  Also known as ‘OPEN COMEDONES’
 Blackheads occur when a pore is clogged
by a combination of sebum and dead skin
cells.

13.  The top of the pore stays open, despite
the rest of it being clogged. This results in
the characteristic black colour seen on the
surface..

14.  Also known as ‘CLOSED COMEDONES’
 Whiteheads can also form when a pore
gets clogged by sebum and dead skin
cells.

15.  Unlike with blackheads, the top of the
pore closes up. It looks like a small bump
protruding from the skin.
 Whiteheads are more difficult to treat
because the pores are already closed.

16.  Pimples that are red and swollen are
referred to as inflammatory acne.

17.  Papules occur when the walls surrounding
your pores break down from severe
inflammation. This results in hard, clogged
pores that are tender to the touch. The
skin around these pores is usually pink.

18.  Pustules can also form when the walls
around your pores break down. Unlike
papules, pustules are filled with pus.
These bumps come out from the skin and
are usually red in colour. They often have
yellow or white heads on top.

19.  Nodules occur when clogged, swollen
pores endure further irritation and grow
larger. Pustules and papules, nodules are
deeper underneath the skin.
 Nodules are so deep within the skin, you
can’t typically treat them at home

20.  Cysts can develop when pores are
clogged by a combination of bacteria,
sebum, and dead skin cells. The clogs
occur deep within the skin and are further
below the surface than nodules.

21.  These large red or white bumps are often
painful to the touch.
 Cysts are the largest form of acne, and
their formation usually results from a
severe infection. This type of acne is also
the most likely to scar.

24.  Genetics is thought to be the primary
cause of acne in 80% of cases.

25.  Possible secondary contributors include
•Hormones
•Genes
•Infections
•Diet
•Environmental factor
•Stress
•Medication

26.  The severity of acne vulgaris can be
classified as mild, moderate, or severe as
this helps to determine an appropriate
treatment regimen.

27.  Mild acne is classically defined by the
presence of clogged skin follicles (known
as comedones) limited to the face with
occasional inflammatory lesions.

29.  Moderate severity acne is said to occurs
when
inflammatory papules and pustules occur
on the face compared to mild cases of
acne and are found on the trunk of the
body.

31.  Severe acne is said to occur
when nodules are the characteristic facial
lesions and involvement of the trunk is
extensive.

34. follicular hyper keratinization
proliferation +
decreased desquamation of keratinocytes
hyperkeratotic plug
(micro comedone)

35. Sebaceous glands enlarge
Sebum production increases
Growth medium for P. Acnes
plugs provide anaerobic

36. Bacteria thrive
Inflammation results
Chemotactic factors attract neutrophils
Depending on conditions
Non-inflammatory
open/closed comedones
Inflammatory papule/
pustule/nodule

37.  Typical features of acne include
 Increased secretion of oily sebum by skin
 micro comedones
 comedones (open &closed)
 papules
 nodules
 pustules, and often results in scarring.

39.  The appearance of acne varies with skin colour.
 It may result in psychological and social problems

40.  Historical and physical clues that may
suggest hormone-sensitive acne include
onset between ages 20 and 30.
 Comedones (blackheads and whiteheads)
must be present to diagnose acne.

41.  Micro comedones are not visible to the
naked eye when inspecting the skin and
can only be seen with a microscope.
 Several scales exist to grade the severity
of acne vulgaris, but no single technique
has been universally accepted.

42.  Cook's acne grading scale uses
photographs to grade severity from 0 to 8
(0 being the least severe and 8 being the
most severe).
 This scale was the first to use a
standardized photographic protocol to
assess acne severity.

43.  Change in sebaceous activity and hormonal level (e.g.
before or during premenstrual cycle)
 High humidity conditions
 Local irritation or friction
 Rough or occlusive clothing
 Cosmetics( having greasy base)
 Diet; chocolate, nuts, fats colas, or carbohydrates.
 Oils greases , or dyes in hair product.

44. Treatment must be long term however symptoms
can be reduced and permanent scaring can be
minimized. It involves:
 Removal of excess sebum by washing the
affected areas three times a day with
warm water and soap.
 Topically applied oils and fats e.g. in
cosmetics should be eliminated.

45.  Benzoyl peroxide (BPO) is a first-line
treatment for mild and moderate acne due
to its effectiveness and mild side-effects.
 Retinoid are medications which reduce
inflammation, normalize the follicle cell life
cycle, and reduce sebum production.

46.  Antibiotics are frequently applied to the
skin or taken orally to treat acne and are
thought to work due to their antimicrobial
activity against P. acnes and their ability
to reduce inflammation.

47.  Hormonal agents: In women, acne can be
improved with the use of any combined
birth control pill. These decrease the
production of androgen hormones by the
ovaries, resulting in lower skin production
of sebum, and consequently reduce acne
severity.

48.  Azelaic acid has been shown to be
effective for mild to moderate acne when
applied topically at a 20% concentration.
 Treatment twice daily for six months is
necessary, and is as effective as topical
benzoyl peroxide 5%, isotretinoin 0.05%,
and erythromycin 2%.

49.  Salicylic acid is a topically applied beta-
hydroxy acid that stops bacteria from
reproducing and has keratolytic
properties. It opens obstructed skin pores
and promotes shedding of epithelial skin
cells.

50.  Topical and oral preparations
of nicotinamide (the amide form of vitamin
B3) have been suggested as alternative
medical treatments. It is thought to
improve acne due to its anti-inflammatory
properties, its ability to suppress sebum
production, and by promoting wound
healing.

51.  Medications of different classes together,
each with a different mechanism of action
has been demonstrated to be a more
efficacious approach to acne treatment
than monotherapy.

52.  The pairing of benzoyl peroxide with a
retinoid is preferred over the combination
of a topical antibiotic with a retinoid since
both regimens are effective but benzoyl
peroxide does not lead to antibiotic
resistance.

53.  Administer prescribed medications, which
may include acne products containing
benzoyl peroxide; topical agents, such as
vitamin A acid; and antibiotics such as
tetracycline.

54.  Provide client and family teaching
 Advise the client that heat, humidity, and
perspiration exacerbate acne.

55.  Explain that uncleanliness, dietary
indiscretions, menstrual cycle, and other
myths are not responsible for acne.
 Explain that it will take 4 to 6 weeks of
compliance with the treatment regimen to
obtain results.

56.  Instruct the female client to inform her
health care provider if she is possibly
pregnant.
 Instruct the client to wash his face gently
(do not scrub) with mild soap twice daily.

57.  Instruct the client not to squeeze
blackheads, not to prop hands on or rub
the face, to wash hair daily and keep it off
the face, and to use cosmetics cautiously
because some may exacerbate acne.

58.  Acute Pain / Chronic Pain related to the
inflammatory process
 Disturbed Body Image related to the state
of the wound.
 Knowledge Deficit related to lack of
information about the disease
 Impaired Skin Integrity related to damage
to the skin surface

59.  Observation of the patient's pain level (0-
10 scale)
 Teach patient distraction techniques,
relaxation and provide comfortable
position.
 Collaboration of analgesic

60.  Involve the family or significant others in
care.
 Note the withdrawn behaviour
increased dependency, manipulation or
not involved in treatment.

61.  Discuss about skin care, for example: use
a moisturizer and sun protection.
 Provide information about hygiene,
disease prevention and treatment.
 Give frequent skin care to prevent dry or
moist.

62.  https://en.wikipedia.org/wiki/Acne
 https://www.healthline.com/health/beauty-skin-care/types-
 https://www.aad.org/public/diseases/acne-and.../how-to-tr
 http://nursingfile.com/nursing-care-plan/nursing-interventio