Acne Vulgaris
-
Upload
farah-basotjatjo-kahar -
Category
Documents
-
view
28 -
download
0
description
Transcript of Acne Vulgaris
![Page 1: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/1.jpg)
ACNE ACNE VULGARISVULGARIS
![Page 2: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/2.jpg)
Acne vulgaris (AV)Acne vulgaris (AV) is a self is a self
limiting disease, seen limiting disease, seen
primarily in adolescents primarily in adolescents
involving the sebaceous involving the sebaceous
follicles.follicles.
Definition
![Page 3: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/3.jpg)
May be present at birth or May be present at birth or
first 6 months of life.first 6 months of life.
In girls, the occurrence of In girls, the occurrence of
acne may precede acne may precede
menarche (14 – 16 years).menarche (14 – 16 years).
Epidemiology
![Page 4: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/4.jpg)
Boys tend to have a peak Boys tend to have a peak incidence between ages 16 & incidence between ages 16 & 19 years.19 years.
Nodulocystic acne to be more Nodulocystic acne to be more common in while males than common in while males than in black males.in black males.
Acne is more severe in Acne is more severe in patient with xyy genotypepatient with xyy genotype
![Page 5: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/5.jpg)
Etiology & Pathogenesis
Basic cause of acne in Basic cause of acne in
unknown.unknown.
Acne is a multifactorial Acne is a multifactorial
disease.disease.
![Page 6: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/6.jpg)
Four principal pathologic in Four principal pathologic in acne are :acne are :1.1. Abnormal follicular Abnormal follicular
keratinization.keratinization.2.2. Increased sebum production.Increased sebum production.3.3. Proliferation of Proliferation of
Propionibacterium acnes in Propionibacterium acnes in the sebum.the sebum.
4.4. Inflammation.Inflammation.
![Page 7: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/7.jpg)
Androgen are known to Androgen are known to
regulate the development of regulate the development of
the sebaceous gland & sebum the sebaceous gland & sebum
production.production.
Patient with acne may have Patient with acne may have
increased levels of circulating increased levels of circulating
androgens.androgens.
![Page 8: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/8.jpg)
Stress is known to increase Stress is known to increase
the output of adrenal steroids, the output of adrenal steroids,
which may affect the which may affect the
sebaceous glands.sebaceous glands.
![Page 9: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/9.jpg)
Clinical Manifestations
Primary site Primary site face, upper face, upper
back, chest, shoulder.back, chest, shoulder.
Lesion may be non Lesion may be non
inflammatory or inflammatory.inflammatory or inflammatory.
![Page 10: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/10.jpg)
Non-inflammatory lesion Non-inflammatory lesion
comedones :comedones :
• Open (blackheads).Open (blackheads).
• Closed (whiteheads).Closed (whiteheads).
![Page 11: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/11.jpg)
Open comedoOpen comedo a flat or a flat or
slightly raised lesion with a slightly raised lesion with a
central dark colored central dark colored
follicular impaction of keratin follicular impaction of keratin
& lipid.& lipid.
![Page 12: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/12.jpg)
Closed comedoClosed comedo pale, pale,
slightly elevated, small slightly elevated, small
papules & do not have a papules & do not have a
clinically visible orifice.clinically visible orifice.
![Page 13: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/13.jpg)
Inflammatory lesions vary Inflammatory lesions vary from small papules with an from small papules with an inflammatory areola to inflammatory areola to pustules to large, fluctuant pustules to large, fluctuant nodules.nodules.Large nodules Large nodules nodulocystic (severe cases nodulocystic (severe cases of inflammatory acne).of inflammatory acne).
![Page 14: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/14.jpg)
Patient may have scars of Patient may have scars of
varying size varying size a sharply a sharply
punched out pit.punched out pit.
![Page 15: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/15.jpg)
Diagnosis
Finding of mixture of Finding of mixture of lesions of acne :lesions of acne :
Comedones.Comedones.Pustules.Pustules.Papules.Papules.Nodules on the face.Nodules on the face.Back.Back.Chest.Chest.
![Page 16: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/16.jpg)
Differential Diagnosis
Folliculitis.Folliculitis.
Rosasea.Rosasea.
Perioral dermatitis.Perioral dermatitis.
![Page 17: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/17.jpg)
Treatment
1.1. Topical therapy :Topical therapy : Tretinoin :Tretinoin :
• Cream : 0,025%, 0,05%, Cream : 0,025%, 0,05%,
0,1%.0,1%.
• Gel : 0,01%, 0,025%.Gel : 0,01%, 0,025%.
• Liquid : 0,05%.Liquid : 0,05%.
![Page 18: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/18.jpg)
Benzoyl peroxideBenzoyl peroxide : lotion, : lotion,
creams, gels, washes creams, gels, washes
(2,5%, 5%, 10% (2,5%, 5%, 10%
concentrations).concentrations).
![Page 19: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/19.jpg)
Topical antibiotics :Topical antibiotics :• Clindamycin : gel, lotion, Clindamycin : gel, lotion,
solution (1%).solution (1%).• Erythromycin in 1 – 2% Erythromycin in 1 – 2%
solution, ointment.solution, ointment.• Azelaic acid : cream 20%.Azelaic acid : cream 20%.• Cleaning agents.Cleaning agents.• Astringents.Astringents.
![Page 20: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/20.jpg)
2.2. Physical therapy :Physical therapy : Cryoslush therapy.Cryoslush therapy. Ultraviolet light.Ultraviolet light. Radiation therapy.Radiation therapy. Acne surgery.Acne surgery. Intralesional Intralesional
corticosteroid : 0,05 – 0,25 corticosteroid : 0,05 – 0,25 ml per lesion ml per lesion (triamcinolone acetate).(triamcinolone acetate).
![Page 21: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/21.jpg)
3.3. Systemic therapy :Systemic therapy : Antibiotic :Antibiotic :• Tetracycline : 500 – 1000 Tetracycline : 500 – 1000
mg/d for 4 – 5 weeks.mg/d for 4 – 5 weeks.Dose can be reduced to a Dose can be reduced to a maintenance level of 250 maintenance level of 250 – 500 mg/d for several – 500 mg/d for several months.months.
![Page 22: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/22.jpg)
• Minocycline : 50 – 100 mg Minocycline : 50 – 100 mg
once ro twice daily.once ro twice daily.
• Doxycycline : 50 mg twice Doxycycline : 50 mg twice
daily, severe cases daily, severe cases 100 mg 100 mg
twice daily.twice daily.
• Sulfonamide.Sulfonamide.
![Page 23: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/23.jpg)
Hormonal therapy :Hormonal therapy :• Estrogens : ethynil Estrogens : ethynil
estradiol 0,035 – 0,050 mg.estradiol 0,035 – 0,050 mg.• Oral contraceptives.Oral contraceptives.• Glucocorticoids.Glucocorticoids.• Gonadotropin-releasing Gonadotropin-releasing
hormon agonists.hormon agonists.• Antiandrogen.Antiandrogen.
![Page 24: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/24.jpg)
Retinoids : Retinoids :
Recommended dose Recommended dose 0.5 0.5
– 2 mg/kg for 15 – 20 – 2 mg/kg for 15 – 20
weeks.weeks.
![Page 25: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/25.jpg)
Favorable with spontaneous Favorable with spontaneous
resolution.resolution.
Physical sequela : Physical sequela : scar scar
special cure (peeling and special cure (peeling and
dermabration).dermabration).
Prognosis
![Page 26: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/26.jpg)
![Page 27: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/27.jpg)
![Page 28: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/28.jpg)
![Page 29: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/29.jpg)
![Page 30: Acne Vulgaris](https://reader036.fdocuments.us/reader036/viewer/2022062310/577cc7651a28aba711a0d0ff/html5/thumbnails/30.jpg)