2. INTRODUCCIÓN
Mahmood NF et al. The age-old problem of acne. Int J Womens Dermatol. 2016 Dec 2;3(2):71-76
Trastorno multifactorial de la
unidad pilosebácea
3. EPIDEMIOLOGÍA
Edad: 12-24 años (85%)
✓ Hasta los 44 años: Hombres: 3% Mujeres: 12%
Caucásicos: Más frecuente el nóduloquístico
Factores de riesgo:
XXY
Endocrinopatías: Hiperandrogenismo, hipercortisolismo
9. CUADRO CLÍNICO: ACNÉ
NODULOQUÍSTICO
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J Am Acad Dermatol. 2017 Jul;77(1):109-117
Nódulos y quistes
11. CUADRO CLÍNICO: FULMINANS
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J
Am Acad Dermatol. 2017 Jul;77(1):109-117
12. CUADRO CLÍNICO: CONGLOBATA
VS FULMINANS
Alakeel A et al Acne Fulminans: Case Series and Review of the Literature. Pediatr Dermatol. 2016 Nov;33(6):e388-e392
13. CUADRO CLÍNICO: ACNÉ
FULMINANS
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J
Am Acad Dermatol. 2017 Jul;77(1):109-117
17. CLASIFICACIÓN: EDAD
Eichenfiel LF et al Evidence-based recommendations for the diagnosis and treatment of pediatric acne- Pediatrics. 2013 May;131 Suppl 3:S163-86
De la mujer adulta > 25 años
24. LABORATORIO Y GABINETE
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J Am Acad Dermatol. 2017 Jul;77(1):109-117
Acné Fulminans
Endocrinopatías
26. DIAGNÓSTICO: ACNÉ
FULMINANS
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J
Am Acad Dermatol. 2017 Jul;77(1):109-117
38. TRATAMIENTO: ACO
Zaenglein AL et al Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33
39. TRATAMIENTO:
ISOTRETINOINA VO
Lee YH et al. Laboratory Monitoring During Isotretinoin Therapy for Acne: A
Systematic Review and Meta-analysis. JAMA Dermatol. 2016 Jan;152(1):35-44
Zaenglein AL et al Guidelines of care for the management of acne
vulgaris. J Am Acad Dermatol. 2016 May;74(5):945-73.e33
Muy
importante!!!
41. TRATAMIENTO: ACNÉ
FULMINANS
Greywal T et al. Evidence-based recommendations for the management of acne fulminans and its variants. J
Am Acad Dermatol. 2017 Jul;77(1):109-117
43. TRATAMIENTO: CICATRICES
DE ACNÉ
Elcin G et al Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: prospective clinical trial with short and long-term
evaluation. Lasers Med Sci. 2017 Sep 11
Fig. 1. Woman with acne on her face Source: Burgess TH. Eruptions of the face, head, and hands: with the latest improvements in the treatment of diseases of the skin [Inter- net]. 1849 [cited 2015 October 6]. Available from: https://commons.wikimedia.org/wiki/File:Illustration_of_a_woman_with_acne_on_her_face_Wellcome_L0037455.jpg
Acne vulgaris is a ubiquitary skin disease characterized by chronic inflammation of the pilosebaceous unit resulting from bacterial colonization of hair follicles by Propionibacterium acnes, androgen-induced increased sebum production, altered keratinization and inflammation.
Comedón temprano: Aumento de la cohesiviad del corneocito e hiperqueratosis del infundíbulo. Hay estímulo de la glándula sebácea
Comedón tardío: Acumulación de sebo y queratina
Pápula-pústula: Proloferación de P acnes, leve inflamación
Nódulo quiste: Inflamación severa, cicatriz (No son quistes verdaderos ya que no estan recubiertos por epitelio)
Crab lice cling to the base of hairs (Fig. 84.11A), and they can be skin-colored or mimic hemorrhagic crusts.
Acne scar subtypes. Acne can lead to a variety of skin changes, including scarring and dyspigmentation. Acne scars can be divided into three main types of scars based on a net loss or gain in collagen (atrophic, hypertrophic, or keloidal). Atrophic acne scars are the most common type and can be further subdivided into rolling, boxcar, and ice-pick
Slit lamp examination: Nits anchored to the eyelashes. A moving insect was observed hanging from an eyelash (red arrow).
FIGURE 3: Bone scintigraphy: multiple osteoarticular processes – indicated by arrows
In contrast to antibiotics commonly used in the treatment of acne, benzoyl peroxide (BP)'s mechanism of action is different. Benzoyl peroxide is a bactericidal agent. Combining BP with a topical antibiotic in a stable formulation has been proven in clinical trials to reduce total P acnes count by 99.7% after 1 week of therapy, eliminating both susceptible and resistant strains of P acnes. However, we have recently noticed BP's benefits as monotherapy in the treatment of acne. Benzoyl peroxide works rapidly on P acnes without causing antibiotic resistance. Hence, we may have to reconsider the role of topical antibiotics such as clindamycin in the treatmentparadigm of acne vulgaris
Although acne is not an infectious disease, oral antibiotics have remained a mainstay of treatment over the last 40 years. The anti-inflammatory properties of oral antibiotics, particularly the tetracyclines, are efficacious in treating inflammatory acne lesions
This meta-analysis showed that (1) isotretinoin is associated with a statistically significant change in the mean value of several laboratory tests (white blood cell count and hepatic and lipid panels), yet (2) the mean changes across a patient group did not meet a priori criteria for high-risk and (3) the proportion of patients with laboratory abnormalities was low. CONCLUSIONS AND RELEVANCE: The evidence from this study does not support monthly laboratory testing for use of standard doses of oral isotretinoin for the standard patient with acne
Isotretinoin treatment for acne does not appear to be associated with an increased risk for depression. Moreover, the treatment of acne appears to ameliorate depressive symptoms
Oral isotretinoin is a very effective treatment for acne vulgaris with no statistically significant difference in clinical efficacy between once and twice daily doses. However, dividing dose to twice per day might cause fewer incidence of side effects without reducing clinical efficacy. The drug causes mild clinically insignificant rise of serum cholesterol, triglycerides, AST, and ALT.
FIGURE 2: Ulceronecrotic lesions on the back
FIGURE 5: After two months of treatment: extensive scars on the back
