this file demonstrates the treatment of acnes

1. ACNE

2.  Definition
Multi-Factorial disease characterized by abnormalities in
sebum production, Follicular desquamation, Bacterial
proliferation and inflammation .
 Prevalence
17 to 28 million Americans suffer from Acne.
85-90% of Teenagers
8% of 25-34 year olds
3% of 35-44 year olds

3.  Acne Pathophysiology :
Acne mostly effect Face, Neck, chest,
shoulders and Back.
To keep the hair and skin well lubricated, your
body depends on sebaceous glands, which
sit just under the skin
These glands secret an oily substance called
sebum. Which coat the skin and hair to
prevent them from drying out

4. Sebum travels up hair follicles and out
through your pores onto the surface of your
skin .
Your follicles routinely shed dead skins
(keratins )
Which sebum carries out of your body
When your body produces extra sebum and
dead skin cells, they can stick together and
clog your pores!

5. Then Bacteria which normally exist in small
amounts in your skin (in the sebaceous
glands) can flourish in the sebum in the
clogged pore because they fed on
triglycerides that found in the sebum.
The cycle keeps on; the Comedo will rupture
either because it's popped by the individual
or through self rupture. This will lead to
inflammation which is the final stage of
acne Pathophysiology.

7.  Common types of Acne
Comedones
A comedo, or basic acne lesion, is a hair follicle that has
become clogged with oil and dead skin cells.
Comedones can develop into bumps called
whiteheads and blackheads.
Blackheads
Blackheads are comedones that are open at the surface of
the skin. It's not dirt that causes the comedone to turn
black. The oil's reaction to air
causes the black color.
Whiteheads
Comedones that stay closed at the surface of the skin are
called whiteheads.

8. Papules
Papules are comedones that become
inflamed, forming small red or pink bumps
on the skin.
Pustules
are another kind of inflamed pimple. They
resemble a whitehead with a red ring
around the bump. The bump is typically
filled with white or yellow pus.

9. Simply it’s HORMONES
the primary hormones behind acne are :
 Insulin and Insulin like growth factor 1
(IGF-1 )
 Androgens (mainly testosterone and DHT)

10. Hormones affect all the steps in the acne
formation process :
 They increase sebum production
 accelerate skin cell growth (thus more dead
cells to eliminate)
 hinder separation of dead skin cells (by up-
regulate keratin levels)
 increase inflammation.

11.  Acne Treatment
Successful treatment outcomes involve
combination therapy with different drug
mechanisms, treating acne should be in
stepwise fashion, otherwise acne will always
find a way to get back !

12.  Topical Pharmacotherapy
Medication
 Benzyl peroxide:
1. Has Anti-Bacterial effect
2. Anti-comedonal (has a drying effect)
3. Removes dead skin cells clogging pores
4. Safe in pregnancy
 Tretinoin:
1. Form of Vit.A, Reduces the buildup of dead
skin cells and helps the skin renew its self
2. Reduce the appearance of fine wrinkles and
mottled skin discoloration

13.  Adapalene:
1. a retinoid-like compound
2. it helps the skin cells renew quicker
3. decreases blackhead formation
 Azelaic acid:
1. helps the skin to renew itself more
quickly
2. therefore reduces pimple and blackhead
formation
3. helps to kill the bacteria that cause acne
and rosacea

14.  Salicylic acid :
1. Slows the loss of skin cells to prevent
clogged pores
2. a keratolytic (peeling agent) may
breakdown whiteheads and blackheads
3. causes shedding of the outer layer of skin
“ These Topical Forms are used for Mild To
Moderate Acne. For better efficacy it could
be used as combination (eg. Adapalene
and Salicylic acid). If they are not effective,
your dermatologist may prescribe stronger
prescription.

15.  Antibiotics
Antibiotics are prescribed to treat
severe acne or acne that is likely to leave
scars. Antibiotics improve the look of your skin
by killing bacteria that cause acne. This means
you'll have fewer pimples and redness.
Less acne means less acne scarring.
Antibiotics may be applied topically or orally.
Topical antibiotics kill bacteria on your skin.
Oral antibiotics kill bacteria in your skin
pores. Oral antibiotics work best if you start
them at high doses then reduce the dose as
your acne gets better.

16. People with mild acne may need only topical antibiotics. The most
common types include:
 Clindamycin
 Erythromycin
A topical antibiotic may be combined with a topical retinoid or with
benzoyl peroxide gel. This can make it less likely that you will
develop antibiotic resistance.
People with severe acne and people who are more likely to have
scarring from acne often take antibiotics by mouth. The most
common oral antibiotics include:
 Erythromycin
 Tetracycline's, which include:
 Doxycycline
 Minocycline
 Depending on the medical condition, antibiotics have to be taken for
several weeks before the infection clears up.

17.  Isotretinoin
In severe cases, oral isotretinoin may be considered. It is used for
treating severe acne in patients who do not respond to
other medicines. It may also be used for other conditions as
determined by your doctor.
1. Isotretinoin is a retinoid.
2. It works by reducing skin oil production,
3. changing the characteristics of the skin oil
4. preventing abnormal hardening of the skin.

19. Before taking isotretinoin
 If you are pregnant, trying for a baby or breast-feeding.
This is very important because isotretinoin is harmful to
babies.
 If you have diabetes.
 If you have a dry eye condition.
 If you have kidney or liver problems.
 If you have been told you have high levels of lipids (fats) in
your blood.
 If you have ever had a mental health problem such as a
depressive illness, or if you have ever had suicidal
thoughts.
 If you know you have a condition called hypervitaminosis
A (too much vitamin A stored in your body).
 If you have ever had an allergic reaction to a medicine, or
if you are allergic to soya or peanuts.
 If you are taking any other medicines. E.g. Antibiotics

20. Birth control pills:
 There is a clear relationship between hormones and acne.
 Androgens stimulate your skin to produce sebum
 Higher levels of androgens can lead to excess sebum
Example:
 Cyproterone acetate & Ethinyl-estradiol
 Cyproterone acetate is a progesterone derivative with anti-
androgenic effects