The document discusses the sebaceous gland and its role in acne pathogenesis. It describes how sebum composition changes in acne, with increased levels of triglycerides, free fatty acids and other lipids that promote P. acnes bacteria growth and inflammation within pilosebaceous follicles. The four main pathologic features of acne are increased sebum production due to androgens, P. acnes infection, follicular hyperkeratinization, and inflammation.

1. Acne &Rosacea

11. 4 main pathologic features of acne

12. Acne P. acnes Inflammation Sebum androgen Follicular keratinization

13. Androgens (DHT) Follicular hyperkeratinization P acnes multiplication Inflammation & immune response  sebum production

15. Androgens Alteration of the follicular milieu Colonization with P. acnes Inflammation Sebocyte Keratinocyte Seborrhea Follicular desquamation

18. Designing an Acne Treatment Plan

20. Moderate acne Systemic treatment Oral antibiotics Appropriate topical treatment + ? Oral isotretinoin

21. Severe acne and Resistant cases Oral isotretinoin

25. Acne vulgaris - Treatment Systemic therapy as oral antibiotics or cyproterone acetate should be given in conjunction with appropriate topical therapy. II) Moderate to severe acne Isotretinoin III) Severe acne

33. Acne type Mild acne “Comedones” Initial therapy Maintenance Mild-to-moderate acne (papular / pustular) Moderate-to-severe acne (severe nodulocystic) T Adapalene or T retinoid or Bpo / T antibiotics T Adapalene + T / oral antibiotic or + Bpo antibiotic or ?? oral isotretinoin Oral isotretinoin or Cyproterone acetate T adapalene (Differin ® ) Failure Failure 3 ms Success After 3 ms success Success

34. Initial therapy Maintenance Acne type Modified from: Leyden, J Am Acad Dermatol, 2003 Oral isotretinoin or Hormonal therapy – women T. Retinoid + T./oral antibiotic or T. retinoid + BPO … antibiotic or fluid active (sebium AKN)  BPO or ?? Oral isotretinoin Failure 3 ms Failure Mild acne “ comedones” Mild-to-moderate acne (papular/pustular) Moderate-to-severe acne (severe nodulocystic) Success T. Retinoid or T. Retinoid + BPO/T. antibiotics After 3 ms success T. Retinoid &/or BPO or Fluidactive (sebium AKN) Success

55. Could acne be related to a change in skin lipid composition irrespective of the rate of sebum excretion ?

56. Squalene “ sebum” Oxidated squalene Hyperproliferation  Sebum fluidity Microcomedo Oxidation

60. … and consider the possibility the patient is excoriating because of demodecideosis Crotamiton or Pyrethrin Acne Excori é e

61. Acne Excori é e Use topicals! … even if you don’t think they help … it gives the patient some way to touch the face without guilt – and without picking

86. Perioral dermatitis Persistent erythematous eruption of tiny papules and pustules around the mouth, nose and may be eyes. A clear zone is often seen around the vermilion border of the lips.