Prof .Atif Kazmi

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  • dr atif hello its me munazza men ne ap k bare men parha hai mere baal bht gir rhe hen skin khali ho rhe hai naey baal nae arhe plz muje btaen men kia krun me 21 years old and unmarried
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Prof .Atif Kazmi

  1. 2. A C N E PROF. SYED ATIF HASNAIN KAZMI President Pakistan Association of Dermatologists Dean Faculty of Medicine & Allied Chairman & Head Department of Dermatology KEMU/ Mayo Hospital, Lahore
  2. 3. Prof. Syed Ghulam Shabbir (Late) Founder of Dermatology in Pakistan
  3. 4. KING EDWARD MEDICAL UNIVERSITY LAHORE
  4. 5. MAYO HOSPITAL LAHORE
  5. 6. ACNE <ul><li>Chronic inflammatory disease of the pilosebaceous follicles seen primarily in adolescents </li></ul>
  6. 7. BASIC LESIONS OF ACNE <ul><li>Non-inflamed lesions </li></ul><ul><li>Comedones </li></ul><ul><li>Inflamed lesions </li></ul><ul><li>Papules </li></ul><ul><li>Pustules </li></ul><ul><li>Nodules </li></ul>
  7. 8. LESIONS <ul><li>Open comedones (black heads) </li></ul><ul><li>Closed comedones (white heads) </li></ul><ul><li>Inflammatory papules </li></ul><ul><li>Pustules </li></ul><ul><li>Nodules </li></ul><ul><li>Cysts </li></ul><ul><li>Scar </li></ul>
  8. 9. Epidemiology <ul><li>80% of adolescents and young adults (11-30 years) </li></ul><ul><li>Both sexes affected, females report earlier </li></ul><ul><li>8-10 years </li></ul>
  9. 10. <ul><li>Pilosebaceous Unit </li></ul><ul><li>Major Factors </li></ul><ul><li>Genetic Predisposition </li></ul><ul><li>Seborrhoea </li></ul><ul><li>Comedogenesis </li></ul><ul><li>Bacterial colonization </li></ul><ul><li>Inflammation </li></ul>
  10. 11. Path o genesis
  11. 12. Path o genesis
  12. 13. Aggravating Factors <ul><li>Drugs: steroids etc. </li></ul><ul><li>Stress </li></ul><ul><li>Occupations: oils, chemicals </li></ul><ul><li>Cosmetics </li></ul><ul><li>Foods ? </li></ul><ul><li>Premenstrual flare </li></ul>
  13. 14. Clinical Features <ul><li>Sites: </li></ul><ul><ul><li>Face </li></ul></ul><ul><ul><li>Back </li></ul></ul><ul><ul><li>Anterior trunk </li></ul></ul><ul><ul><li>Upper arms </li></ul></ul><ul><li>Pleomorphic lesions </li></ul>
  14. 15. M o derate Mi I d Severe GRADING
  15. 16. TYPES OF ACNE
  16. 17. ACNE VULGARIS
  17. 18. NODULO-CYSTIC ACNE
  18. 19. PUSTULAR ACNE
  19. 20. PYODERMA FACIALE
  20. 21. ACNE CONGLOBATA
  21. 22. STEROID ACNE
  22. 23. NEONATAL ACNE
  23. 24. ACNE EXCORIEE
  24. 25. ACNE AGMINATA
  25. 26. POMADE ACNE
  26. 27. Management <ul><li>Severity of acne </li></ul><ul><li>Presence or likelihood of scarring </li></ul><ul><li>Psychological impact of the disease </li></ul><ul><li>Experience with anti-acne therapy </li></ul><ul><li>Pregnancy </li></ul>
  27. 28. <ul><li>Patient education </li></ul><ul><li>Removal of aggravating factors </li></ul><ul><li>Pharmaceutical treatment </li></ul><ul><li>Adjunct therapies </li></ul><ul><li>Maintenance therapy </li></ul>Management ( contd)
  28. 29. Patient Education <ul><li>Acne is </li></ul><ul><li>Not infectious/contagious </li></ul><ul><li>Not caused by poor hygiene </li></ul><ul><li>Not to pick/scratch lesions </li></ul><ul><li>Acne may worsen premenstrually </li></ul><ul><li>Improvement may take 4-6 weeks </li></ul><ul><li>Worsening may occur during early weeks </li></ul>
  29. 30. <ul><li>Encouragement to continue the therapy </li></ul><ul><li>Whole face needs to be treated and not the visible spots only </li></ul>Patient Education ( contd )
  30. 31. Topical Therapies <ul><li>Retinoids ( Isotrex ) </li></ul><ul><li>Benzoyl peroxide ( Brevoxyl ) </li></ul><ul><li>Antibiotics ( Clinagel ) </li></ul><ul><li>Azelaic acid </li></ul><ul><li>Combination Drugs e.g. Isotrexin ---Isotretinoin & Erythromycin and Duac ---Clindamycin & Benzoyl Peroxide </li></ul>
  31. 32. Systemic Therapies <ul><li>Antibiotics ( Minoderm ) </li></ul><ul><li>Retinoids </li></ul><ul><li>Dapsone </li></ul><ul><li>Steroids </li></ul>
  32. 36. Why to use Isotretinoin? <ul><li>Nodulocystic, disfiguring, resistant acne </li></ul><ul><li>Presence or likelihood of scarring </li></ul><ul><li>Psychological distress </li></ul><ul><li>Prevention of suicidal tendency </li></ul>
  33. 37. Nodulocystic Acne
  34. 38. Nodulocystic Acne
  35. 39. Acne Conglobata Severe Form of Nodulocystic Acne
  36. 40. Severe Form of Nodulocystic Acne Acne Conglobata
  37. 41. Nodulocystic Acne
  38. 42. Isotretinoin Therapy Before After
  39. 43. Isotretinoin Side Effects <ul><li>Many General side effects have been reported such as; dryness of the skin and mucous membranes, photophobia, muscle and joint pain, insomnia, lethargy </li></ul><ul><li>Central Nervous System side effects include pseudotumor cerebri, visual disturbances, hearing deficiencies, headache, nausea, malaise and drowsiness, Amnesia, hallucinations </li></ul><ul><li>Psychiatric disorders include behavioural disorders, seizures, psychosis, schizophrenia, depression, suicide ideation, suicide attempt and suicide </li></ul><ul><li>Isotretinoin is also a teratogen </li></ul>
  40. 44. DRY EYE
  41. 45. CHEILITIS
  42. 46. Mucocutaneous side effects are inevitable but easily tolerated. The lips and nose are always affected by drying
  43. 48. Sunburn after Isotretinoin Therapy
  44. 49. Acute paronychia after Isotretinoin therapy
  45. 50. MOOD CHANGE - DEPRESSION
  46. 51. Adjunct therapies <ul><li>Skin care </li></ul><ul><ul><li>Normal washing, twice daily </li></ul></ul><ul><ul><li>Avoid physical scrubs </li></ul></ul><ul><ul><li>Soaps containing chlorhexidine not beneficial </li></ul></ul><ul><li>Comedo extractor/electrocautery </li></ul><ul><li>Chemical peeling </li></ul><ul><li>Microderm abrasion/Laser Resurfacing </li></ul><ul><li>Fillers </li></ul>
  47. 52. Course and Prognosis <ul><li>Mostly clear by early twenties </li></ul><ul><li>Some may continue in third/fourth decade </li></ul><ul><li>Residual scarring </li></ul>
  48. 53. Myths <ul><li>Acne only appears during teenage </li></ul><ul><li>Marriage will improve acne </li></ul><ul><li>Acne should not be treated </li></ul><ul><li>Spicy foods, eggs, mangoes cause acne </li></ul><ul><li>Betnovate/Archi/Stillmans improve acne </li></ul>
  49. 54. <ul><li>THANK YOU </li></ul>

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