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ACNE VULGARIS


   Abdul Alraiyes
     5/7/08
ACNE VULGARIS
   SELF-LIMITED DISORDER OF PILOSEBACEOUS UNIT
   PRIMARILY IN ADOLESCENTS
   PLEOMORPHIC VARIETY OF LESIONS- COMEDONES,
    PAPULES, PUSTULES, NODULES
   GENETIC FACTORS PLAY A ROLE IN ACNE SEVERITY
   MEDICATIONS LIKE CORTICOSTEROIDS, ISONIAZID,
    PHENYTOIN, LITHIUM, PROGESTINS
   CAN CAUSE ACNELIKE LESIONS
PATHOGENESIS
 FOUR KEY ELEMENTS:
 FOLLICULAR HYPERKERATINIZATION
 SEBUM ACCUMULATION
 INFLAMMATION
 PRESENCE & ACTIVITY OF Propionibacterium
  acnes
 ANDROGENS PLAY A PIVOTAL ROLE
 INCREASE SEBUM PRODUCTION & ENLARGE
  SEBACEOUS GLANDS
CLINICAL FEATURES

 OPEN & CLOSED COMEDOS, ERYTHEMATOUS
  PAPULES, PUSTULES, NODULES, CYSTS &
  SCARS
 FACE, TRUNK & CHEST

 INFLAMATORY & NON-INFLAMMATORY LESIONS

 SCARRING IS A COMPLICATION OF BOTH.
CLINICAL VARIANTS OF ACNE

   ACNE
    CONGLOBATA:
    severe, scarring form of
    acne where large
    nodules and abscesses
    become confluent to
    form draining sinus
    tracts
ACNE CONGLOBATA
CLINICAL VARIANTS OF ACNE

   ACNE COSMETICA:
    persistent, low grade form
    of acne result from use of
    cosmetics, moisturizers,
    sunscreens This type of
    acne responds particularly
    well to the topical
    application of tretinoin.
CLINICAL VARIANTS OF ACNE

   ACNE MECHANICA:
    results from repeated trauma
    associated with sports
    helmet, shoulder pads, chin
    rests of violoins and violas.
CLINICAL VARIANTS OF ACNE

   Acne fulminans :
    severe, scarring form of acne
    with systemic signs and
    symptoms of infection and
    Leukocytosis.
CLINICAL VARIANTS OF ACNE

   NEONATAL ACNE &
    INFANTILE ACNE
CLINICAL VARIANTS OF ACNE

   STERIODS ACNE
DIFFERENTIAL DIAGNOSIS

   FOLLICULITIS :
    PAPULES, PUSTULES,
    NO COMEDOS. USUALLY
    AFFECTS TRUNK &
    EXTREMITIES
DIFFERENTIAL DIAGNOSIS

   PERIORAL
    DERMATITIS: LONG
    TERM USE OF TOPICAL
    CORTICOSTEROIDS ON
    FACE CAN RESULT IN
    ACNEIFORM,
    ERYTHEMATOUS,
    INFLAMED PINK PAPULES
    ON CHIN & CHEEKS.
DIFFERENTIAL DIAGNOSIS

   MILIA : WHITE, PINPOINT
    EPIDERMAL CYSTS AROUND
    EYES
TREATMENT
  TOPICAL THERAPY:
Comedonal acne: Topical retinoids –tretinoin,
   adaplene, tazarotene
Anti-inflammatory & reduce follicular
   hyperkeratinization
Inflammatory acne: Topical antibiotics with benzoyl
   peroxide & topical retinoids
Azelaic acid : antimicrobial & comedolytic properties
Salicylic acid
TREATMENT
  SYSTEMIC THERAPY
Antibiotics: A trial of 8-12 weeks is warranted to
   assess responsiveness.
Doxycycline, minocycline, trimethoprim-
   sulfamethoxazole
Isotretinoin: Cases of Refractory deep
   inflammmatory acne vulgaris
Hormonal therapy: OCPs , spironolactone
Intralesional glucocorticoids; deep nodular lesions
THANKS

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Acne

  • 1. ACNE VULGARIS Abdul Alraiyes 5/7/08
  • 2. ACNE VULGARIS  SELF-LIMITED DISORDER OF PILOSEBACEOUS UNIT  PRIMARILY IN ADOLESCENTS  PLEOMORPHIC VARIETY OF LESIONS- COMEDONES, PAPULES, PUSTULES, NODULES  GENETIC FACTORS PLAY A ROLE IN ACNE SEVERITY  MEDICATIONS LIKE CORTICOSTEROIDS, ISONIAZID, PHENYTOIN, LITHIUM, PROGESTINS  CAN CAUSE ACNELIKE LESIONS
  • 3. PATHOGENESIS  FOUR KEY ELEMENTS:  FOLLICULAR HYPERKERATINIZATION  SEBUM ACCUMULATION  INFLAMMATION  PRESENCE & ACTIVITY OF Propionibacterium acnes  ANDROGENS PLAY A PIVOTAL ROLE  INCREASE SEBUM PRODUCTION & ENLARGE SEBACEOUS GLANDS
  • 4. CLINICAL FEATURES  OPEN & CLOSED COMEDOS, ERYTHEMATOUS PAPULES, PUSTULES, NODULES, CYSTS & SCARS  FACE, TRUNK & CHEST  INFLAMATORY & NON-INFLAMMATORY LESIONS  SCARRING IS A COMPLICATION OF BOTH.
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  • 9. CLINICAL VARIANTS OF ACNE  ACNE CONGLOBATA: severe, scarring form of acne where large nodules and abscesses become confluent to form draining sinus tracts
  • 11. CLINICAL VARIANTS OF ACNE  ACNE COSMETICA: persistent, low grade form of acne result from use of cosmetics, moisturizers, sunscreens This type of acne responds particularly well to the topical application of tretinoin.
  • 12. CLINICAL VARIANTS OF ACNE  ACNE MECHANICA: results from repeated trauma associated with sports helmet, shoulder pads, chin rests of violoins and violas.
  • 13. CLINICAL VARIANTS OF ACNE  Acne fulminans : severe, scarring form of acne with systemic signs and symptoms of infection and Leukocytosis.
  • 14. CLINICAL VARIANTS OF ACNE  NEONATAL ACNE & INFANTILE ACNE
  • 15. CLINICAL VARIANTS OF ACNE  STERIODS ACNE
  • 16. DIFFERENTIAL DIAGNOSIS  FOLLICULITIS : PAPULES, PUSTULES, NO COMEDOS. USUALLY AFFECTS TRUNK & EXTREMITIES
  • 17. DIFFERENTIAL DIAGNOSIS  PERIORAL DERMATITIS: LONG TERM USE OF TOPICAL CORTICOSTEROIDS ON FACE CAN RESULT IN ACNEIFORM, ERYTHEMATOUS, INFLAMED PINK PAPULES ON CHIN & CHEEKS.
  • 18. DIFFERENTIAL DIAGNOSIS  MILIA : WHITE, PINPOINT EPIDERMAL CYSTS AROUND EYES
  • 19. TREATMENT  TOPICAL THERAPY: Comedonal acne: Topical retinoids –tretinoin, adaplene, tazarotene Anti-inflammatory & reduce follicular hyperkeratinization Inflammatory acne: Topical antibiotics with benzoyl peroxide & topical retinoids Azelaic acid : antimicrobial & comedolytic properties Salicylic acid
  • 20. TREATMENT  SYSTEMIC THERAPY Antibiotics: A trial of 8-12 weeks is warranted to assess responsiveness. Doxycycline, minocycline, trimethoprim- sulfamethoxazole Isotretinoin: Cases of Refractory deep inflammmatory acne vulgaris Hormonal therapy: OCPs , spironolactone Intralesional glucocorticoids; deep nodular lesions
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