Label-Retaining Cells Reside in the Bulge Area of Pilosebaceous Unit
Sebaceous Disorders - Acne · Acne •Inflammatory disorder of the pilosebaceous unit •Affects...
Transcript of Sebaceous Disorders - Acne · Acne •Inflammatory disorder of the pilosebaceous unit •Affects...
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Acne vulgaris
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• Stimulated by androgens
• Sebum: triglycerides, free fatty acids, wax esters, squalene, cholesterol
• Sebum functions:
– Waterproof
– mildly bactericidal
– mildly fungistatic
Sebaceous Glands
• Multilobed gland with lipid-containing cells
• Associated with hair follicles (face, behind ears, upper chest and back) or in the epidermis (eyelid, mucous membranes, nipple, genitalia)
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Acne
• Inflammatory disorder of the pilosebaceous unit
• Affects mainly teenagers
• Starting between 12 and 14 years - earlier in females.
• It affects the sexes equally
• Has marked effects on QOL
• Clears by age 23-25 in 90%
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Causes - multifactorial • Over-production of sebum
• Androgens excessive response to normal levels
• Occlusion of skin pores genetic, cosmetics
• Increased bacterial colonisation P.Acnes
• Genetics
• Diet dairy?
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Presentation • On the face, shoulders, upper chest and back. • Seborrhoea (a greasy skin). • Open comedones (blackheads), because of the plugging by keratin and sebum of
the pilosebaceous orifice • or closed comedones (whiteheads), caused by overgrowth of the follicle
openings by surrounding epithelium. • Inflammatory papules, nodules and cysts • Depressed or hypertrophic scarring and post-inflammatory hyperpigmentation
can follow. • Conglobate (gathered into balls) is : a severe form of acne with all of the above
features as well as abscesses or cysts with intercommunicating sinuses that contain thick serosanguinous fluid or pus.
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Variants of acne Neonatal acne • > 20%of healthy newborn babies between 2 weeks to 3
months of age • due to transplacental stimulation of a child’s sebaceous
glands by maternal androgens Infantile acne (rare) • at 3– 6 months of age and typically resolves in 12 months. Late onset • mainly in women and is often limited to the chin and
jawline • Nodular and cystic lesions predominate. • It is stubborn and persistent.
Acne fulminans. (rare) • conglobate acne + fever, joint pains and a high
(ESR).
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Mechanical : Excessive scrubbing, picking or the rubbing of chin straps or a fiddle can rupture occluded follicles.
Tropical : Associated with heat and humidity / mainly on the trunk and may be conglobate. Excoriated : This is most common in young girls. / Obsessional picking or rubbing leaves discrete denuded areas. Exogenous : Tars, chlorinated hydrocarbons, oils and oily cosmetics may induce comedone formation or precipitate inflammation around vellous hair follicles. Drug-induced : Corticosteroids, androgenic and anabolic steroids, gonadotrophins, oral contraceptives, lithium, iodides, bromides, antituberculosis and anticonvulsant therapy Polycystic ovarian syndrome. Congenital adrenal hyperplasia Androgen-secreting tumours
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Investigations • None are usually necessary. • Only a few laboratories routinely culture P. acnes
and test its sensitivity to antibiotics. • Cultures to exclude a pyogenic infection, an
anaerobic infection or Gram-negative folliculitis. • Any acne associated with virilization, needs
investigation to exclude an androgen-secreting tumour
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Treatment Topical • Gentle cleansing • Salicylic acid (comedones) • Benzoyl peroxide (inflammatory) • Vitamin A analogues (comedones)
– Tretinoin, isotretinoin, adapalene – Topical retinoids should not be prescribed for pregnant woman with acne.
• Azelaic acid (inflammatory, bactericidal) • Antibiotics *resistance*
– Clindamycin, erythromycin
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Systemic • Erythromycin
– Erythromycin resistance in P.Acnes
• Tetracyclines – Oxytetracycline, tetracycline, lymecycline, doxycycline,
minocycline – Avoid in pregnancy and <9years – Minocycline side effects pigmentation & lupus-like syndrome
• Trimethoprim • Co-cyprindiol (dianette)
– Risk of VTE use only for 3 months after acne clears
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Isotretinoin • Oral retinoid • Inhibits sebum excretion, inflammation and P.Acnes • Indication
– severe nodulocystic acne – scarring acne – non-responsive acne
• Side effects : – May flare on initiation – can use lower dose in first month(s) – Teratogenic – Risk of depression and suicidality – Dry skin, dry nose/lips/eyes – facial erythema – muscle aches – hyperlipidaemia – hair loss – Rare serious: loss of night vision, pancreatitis, hepatotoxicity, pseudotumour cerebri, hearing
loss
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Treatment • Occasionally, an underlying cause is found; this should be removed or treated. • Local treatment for comedo-papular acne • both local and systemic treatments are needed for pustulocystic scarring acne
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