This document discusses acne, its causes, types, and treatment options. It defines acne vulgaris as a chronic inflammatory skin condition characterized by open or closed comedones (blackheads and whiteheads) and inflammatory lesions. The main bacteria implicated is Propionibacterium acnes. Treatment involves topical retinoids, benzoyl peroxide, antibiotics, and oral antibiotics or isotretinoin for more severe cases. Lifestyle factors like diet are not proven to affect acne. The document provides an overview of acne pathogenesis and management.

1. ACNEACNE
Jorge RozeiraJorge Rozeira
Serviço de DermatologiaServiço de Dermatologia
Hospital Pedro HispanoHospital Pedro Hispano
ULSMULSM
20082008

2. DefinitionsDefinitions
Acne vulgaris is a chronicAcne vulgaris is a chronic
inflammatory dermatosis which isinflammatory dermatosis which is
notable for open and/or closednotable for open and/or closed
comedones (blackheads andcomedones (blackheads and
whiteheads) and inflammatorywhiteheads) and inflammatory
lesions including papules,lesions including papules,
pustules, or nodules.pustules, or nodules.

6. Propionibacterium acnesPropionibacterium acnes
The prevalent bacteriumThe prevalent bacterium
implicated in the clinicalimplicated in the clinical
course of acne iscourse of acne is
Propionibacterium acnes (PPropionibacterium acnes (P
acnes)acnes)..

7. Gram-negative folliculitisGram-negative folliculitis
Gram-negative folliculitis is typicallyGram-negative folliculitis is typically
characterized by pustules and/or nodulescharacterized by pustules and/or nodules
most commonly located in the perioral andmost commonly located in the perioral and
nasal areas.nasal areas.
Gram-negative folliculitis is caused by aGram-negative folliculitis is caused by a
variety of bacteria and is unresponsive tovariety of bacteria and is unresponsive to
conventional antibiotic therapy for acne.conventional antibiotic therapy for acne.

9. AndrogensAndrogens
Although androgens play anAlthough androgens play an
important role inimportant role in
the pathogenesis of acne, mostthe pathogenesis of acne, most
patients have normal hormonepatients have normal hormone
levelslevels

10. Prepubertal ChildrenPrepubertal Children
prepubertal children, the signsprepubertal children, the signs
include acne, early-onset bodyinclude acne, early-onset body
odor, axillary or pubic hair,odor, axillary or pubic hair,
accelerated growth, advancedaccelerated growth, advanced
bone age, and genital maturation.bone age, and genital maturation.

12. After PubertyAfter Puberty
After puberty, commonAfter puberty, common virilizingvirilizing
signs and symptomssigns and symptoms are infrequent.are infrequent.
Menses, hirsutism, male or femaleMenses, hirsutism, male or female
pattern alopecia, infertility, polycysticpattern alopecia, infertility, polycystic
ovaries, clitoromegaly, acanthosisovaries, clitoromegaly, acanthosis
nigricans, and truncal obesitynigricans, and truncal obesity

13. TestosteroneTestosterone
free testosterone,free testosterone,
dehydroepiandrosterone sulfate,dehydroepiandrosterone sulfate,
leutinizing hormone, and follicule-leutinizing hormone, and follicule-
stimulating hormonestimulating hormone

14. Recommendations for topical therapyRecommendations for topical therapy
 RetinoidsRetinoids
 Benzoyl peroxideBenzoyl peroxide
 AntibioticsAntibiotics
 Other agentsOther agents

15. Topical TherapyTopical Therapy
Topical therapy is aTopical therapy is a
standard of care instandard of care in
acne treatmentacne treatment

16. Topical retinoidsTopical retinoids
Topical retinoids are importantTopical retinoids are important
in acne treatmentin acne treatment..

17. Benzoyl PeroxideBenzoyl Peroxide
Benzoyl peroxide andBenzoyl peroxide and
combinations with erythromycincombinations with erythromycin
or clindamycin are effectiveor clindamycin are effective
acne treatmentsacne treatments

18. Recommendations for systemic antibioticsRecommendations for systemic antibiotics
 TetracyclinesTetracyclines
 MacrolidesMacrolides
 Trimethoprim-Trimethoprim-
sulfamethoxazolesulfamethoxazole

20. Topical antibioticsTopical antibiotics
Topical antibiotics (eg,Topical antibiotics (eg,
erythromycin and clindamycin)erythromycin and clindamycin)
are effective acne treatments.are effective acne treatments.
Bacterial resistanceBacterial resistance

21. Salicylic acidSalicylic acid
Salicylic acid is moderatelySalicylic acid is moderately
effective in the treatment ofeffective in the treatment of
acneacne..

22. Azelaic AcidAzelaic Acid
Azelaic acid has beenAzelaic acid has been
shown to be effective inshown to be effective in
clinical trialsclinical trials

23. OthersOthers
the efficacy of sulfur,the efficacy of sulfur,
resorcinol, sodiumresorcinol, sodium
sulfacetamide, aluminumsulfacetamide, aluminum
chloride, and zinc arechloride, and zinc are
limited.limited.

24. Tretinoin,Tretinoin,
AdapaleneAdapalene
TazaroteneTazarotene
IsotretinoinIsotretinoin

25. Combinations:Combinations:
Retinoids,Retinoids,
Benzoyl peroxide,Benzoyl peroxide,
Topical antibioticsTopical antibiotics

26. Systemic antibioticsSystemic antibiotics
Systemic antibiotics are aSystemic antibiotics are a
standard of care in thestandard of care in the
management ofmanagement of moderatemoderate
and severe acneand severe acne andand
treatment-resistant formstreatment-resistant forms
of inflammatory acneof inflammatory acne

27. AntibioticsAntibiotics
Doxycycline andDoxycycline and
minocycline are moreminocycline are more
effective thaneffective than
tetracyclinetetracycline

29. Contraceptive agentsContraceptive agents
SpironolactoneSpironolactone
Antiandrogens,Antiandrogens,
Oral corticosteroidOral corticosteroid

31. EstrogenEstrogen
Estrogen-containing oralEstrogen-containing oral
contraceptives can be useful incontraceptives can be useful in
the treatment of acne in somethe treatment of acne in some
women.women.

32. SpironolactoneSpironolactone
Cyproterone Acetate,Cyproterone Acetate,
Flutamide,Flutamide,
FinasterideFinasteride
(hepatic toxicity limits its(hepatic toxicity limits its
use)use)

33. Oral corticosteroid therapy isOral corticosteroid therapy is
of benefit in patients whoof benefit in patients who
have severe inflammatoryhave severe inflammatory
acne.acne.
(In patients who have adrenal(In patients who have adrenal
hyperandrogenism).hyperandrogenism).

34. Norgestimate with EthinylNorgestimate with Ethinyl
EstradiolEstradiol
Norethindrone Acetate withNorethindrone Acetate with
EthinylEthinyl EstradiolEstradiol
Norethindrone Acetate withNorethindrone Acetate with
Ethinyl EstradiolEthinyl Estradiol

35. Anti-Androgen at higher doses.Anti-Androgen at higher doses.
Dosages of 50 mg to 200 mg.Dosages of 50 mg to 200 mg.
(hyperkalemia, menstrual irregularity)(hyperkalemia, menstrual irregularity)

37. Higher doses have been found toHigher doses have been found to
be more effective than lower dosesbe more effective than lower doses

39. FinasterideFinasteride
CimetidineCimetidine
ketoconazoleketoconazole

41. Oral isotretinoin is approvedOral isotretinoin is approved
for the treatment offor the treatment of severesevere
recalcitrant nodularrecalcitrant nodular
acneacne

43. Intralesional steroidsIntralesional steroids
Chemical peelsChemical peels
Comedo removalComedo removal

45. Intralesional corticosteroidIntralesional corticosteroid
injections are effective in theinjections are effective in the
treatment of individual acnetreatment of individual acne
nodules.nodules.

47. Glycolic Acid PeelsGlycolic Acid Peels
Salicylic Acid PeelsSalicylic Acid Peels
TCATCA
Laser’sLaser’s

49. Herbal agentsHerbal agents
PsychologicalPsychological
approachesapproaches
Hypnosis/biofeedbackHypnosis/biofeedback

50. These studies fail to support aThese studies fail to support a
link between the consumption oflink between the consumption of
chocolate or sugar and acne.chocolate or sugar and acne.
No evidence exists on theNo evidence exists on the
role of diet in acne.role of diet in acne.

52. ACNEACNE
Obrigado!Obrigado!