The document discusses acne, including types of acne like acne vulgaris, closed and open comedones, papules and pustules. It describes more severe forms like acne conglobata and fulminans. It discusses pathogenesis and risk factors. Treatment options covered include topical therapies like retinoids and benzoyl peroxide, oral antibiotics like tetracycline and minocycline, and oral retinoids like isotretinoin. Side effects of various treatments are also summarized.

1. ACNE
GROUP MEMBERS:
B-5 SHAIKH MUSKAN SHAMIM
B-6 SHANKPAL KRISHNA MADHUKAR
B-7 SHANMUGAM RAJESH
B-8 SHANMUGAM SARAVANA KUMAR ASHWATH KUMAR

2. TYPES OF ACNE
• Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous follicles, characterized by comedones,
papules, pustules, nodules, and often scars.
• The comedo is the primary lesion of acne may be seen as a
flat or slightly elevated papule with a dilated central opening
filled with blackened keratin (open comedo or blackhead).
• Closed comedones (whiteheads) are usually 1-mm yellowish
papules that may require stretching of the skin to visualize.
• Macrocomedones- uncommon 3–4 mm in size.
• The papules and pustules are 1–5 mm in size and are caused
by inflammation, so erythema and edema occur. They may
enlarge, become more nodular and coalesce into plaques of
several centimeters that are indurated or fluctuant, contain
sinus tracts, and discharge serosanguineous or yellowish
pus.

4. • ACNE CONGLOBATA : Cystic acne is the mildest form, an unusually
severe type of acne. This form is characterized by numerous
comedones (many of which are double or triple) and large abscesses
with interconnecting sinuses, cysts, and grouped inflammatory
nodules
• Acne fulminans is a rare form of extremely severe cystic acne that
occurs primarily in teenage boys characterized by highly inflammatory
nodules and plaques that undergo swift suppurative degeneration,
leaving ragged ulcerations with hemorrhagic crusts mostly on the
chest and back.
• Acne excorieé: aka picker’s acne and acne excoriée des jeunes filles,
seen in young women with a superficial type of acne. The primary
lesions are trivial or even nonexistent, but the compulsive habit of
picking the face and squeezing minute. Comedones produces
secondary lesions that crust and may leave scars. it may be a sign of
depression or anxiety

6. Pathogenesis
• Comedo formation – impaction and
distension of the follicles with keratinous
plug.
• Follicular hyperproliferation and abnormal
differentiation of keratinocytes.
• Increase in sebum secretion
• Disruption of follicular epithelium, infection
with Propionibacterium acnes
• Formation of Inflammatory papules,
pustules and nodulocystic lesions

7. Risk factors
• Comedogenic greasy or occlusive products
• Skin irritation due to mechanical or frictional forces or by
overexuberant washing.
• Family history
• hyperandrogenic conditions like PCOS and tumors of adrenal
gland or ovaries.

8. Complications
• Scarring
• Hyperpigmentation
• Solid facial edema

9. CLASSIFICATION OF ACNE

10. MILD
COMEDONAL :
➢ Topical retinoid (+/-) Physical extraction ( first line treatment )
➢ Alternate retinoid, benzoyl peroxide salicylic acid, azelaic acid (second line treatment)
PAPULAR/ PUSTULAR :
➢Benzoyl peroxide or topical antimicrobial combination + topical retinoid, benzoyl peroxide wash if
mild truncal lesions ( first line treatment )
➢Alternate antimicrobial combination + alternate topical retinoid, azelaic acid, Soidum
sulfacetamide – sulfur ( second line treatment )

11. MODERATE
PUSTULAR/ PUSTULAR :
IN MEN :
➢Oral antibiotic + topical retinoid + benzoyl peroxide(first line treatment)
➢Alternate antibiotic, alternate topical retinoid (second line); if moderately severe, isotretinoin
IN WOMEN
➢Spironolactone and/or oral contraceptive + topical retinoids ± benzoyl peroxide; oral antibiotic +
topical retinoid + benzoyl peroxide (alternative)
➢Isotretinoin if relapses quickly off oral antibiotics, does not clear, or scars

12. SEVERE
NODULAR/ CONGLOBATE
➢Isotretinoin
➢Oral antibiotic + Oral contraceptive + topical retinoid (+/-) topical or oral antibiotics or benzoyl
peroxide.

13. TREATMENT FOR ACNE

14. TOPICAL THERAPY
All topical treatments are preventive, and use for 8–12 weeks is required to judge their efficacy.
Topical retinoids: topical retinoids are effective in promoting normal desquamation of the follicular
epithelium, reducing comedones and inhibiting the development of new lesions.
• Tretinoin was the first of this group of agents to be used for acne. Popular forms of tretinoin are
0.025% and 0.05% in a cream base and the micronized gels. Tretinoin treatment may take 8–12
weeks before improvement occurs. Tretinoin should be applied at night and is in pregnancy
category C
• Adapalene is a well-tolerated retinoid-like compound that has efficacy equivalent to the lower
concentrations of tretinoin. Because it is light stable, adapalene may be applied in either the
morning or the evening. It is in pregnancy category C.
• Tazarotene is comparatively strong in its action when compared to other retinoids. As it is in
pregnancy category x, contraceptive counseling should be provided.

15. • Benzoyl peroxide: Benzoyl peroxide has a potent antibacterial effect. Its concomitant use with
antibiotics limits the resistance of bacteria such as Propionibacterium acnes even given for short 2
to 7 day pulses. Although effective in inflammatory acne, it also shown to be comedolytic.
Treatment is usually once or twice daily. It may irritate the skin and produce peeling. So, Water-
based formulations of lowest strength are least irritating. Benzoyl peroxide is in pregnancy
category C.
• Topical Anti-bacterials: Topical clindamycin and erythromycin are available in a number of
formulations and are effective in mild inflammatory acne. Use of these topical antibiotics alone,
however, is not recommended because they may induce antibiotic resistance
• Combination topical therapy: Several products are available that combine antibiotics such as
clindamycin and benzoyl peroxide or combine retinoids and either antibiotics or benzoyl peroxide.
However these medications require only less application , combination topical therapy limits
flexibility and may cause more irritation than a single product used alone.

16. ORAL ANTIBIOTICS
Oral antibiotics are indicated for:
• Moderate to severe acne
• In patients with inflammatory disease who do not tolerate or respond to topical combinations
• For the treatment of chest, back, or shoulder acne
• And in patients who scar with each lesion or who develop inflammatory hyperpigmentation.
It generally takes 8–12 weeks to judge efficacy. Starting at a high dose and stopping it after achieving
control is preferred.

17. • Tetracycline
Dosage: 50-100 mg once or twice in a day, depending on the severity of disease.
Side effects: photosensitivity reactions, vaginitis or perianal itching, GI symptoms such as nausea
Tetracycline to be avoided in pregnant women, children under age 9 or 10 and for those with renal
impairment.
• Minocycline
Minocycline is effective in treating acne vulgaris.
Dosage: 50–100 mg once or twice daily, depending on the severity of disease.
Side effects: vertigo, pigmentation in areas of inflammation, lupus-like syndromes, a hypersensitivity
syndrome (fever, hepatitis, and eosinophilia), serum sickness, pneumonitis, and hepatitis.

18. • Amoxicillin.
For those who cannot take tetracyclines because of side effects, or in pregnant women requiring
oral antibiotic therapy, amoxicillin may be useful.
Dosage: 250 mg daily to 500 mg three times daily
Side effects: allergic reactions, which may be serious, and GI upset.
Other antibiotics include sulfonamides, clindamycin, trimethoprim and sulfamethaxazole which are
also effective and used if the patient is unresponsive to other antibiotics;

19. • ORAL RETINOIDS
Isotretinoin
Isotretinoin is a reliable remedy in almost all acne patients.
Dosage: The dose of isotretinoin is 0.5–1 mg/kg/day in one or two daily doses. For severe truncal acne in
patients who tolerate higher doses, up to 2 mg/kg/day may be given. Doses as low as 0.1 mg/kg/day are
almost as effective as the higher doses in clearing acne. To achieve potentially prolonged remission,
patients should receive 120–150 mg/kg over the treatment course.
Side effects:
• Its most serious adverse effect is the risk of severe damage to the fetus if given during pregnancy. It
might cause Retinoid embryopathy which is a well-defined syndrome characterized by craniofacial,
cardiovascular, CNS, and thymus abnormalities. Women should not become pregnant until stopping
medication for at least 1 month.
• Reports of depression, psychosis, suicidal ideation, suicide, and attempted suicide have prompted
numerous studies of the mental health of patients taking isotretinoin
• Inflammatory bowel disease (IBD) is a third concern. Long-term use of tetracycline medications and
severe acne itself may be predisposing factors for IB
• Other side effects of isotretinoin such as are dose dependent and generally not serious.