30 Union Street Montego Bay ,Tel 979-9968, 398- 8349 Acne: - PowerPoint PPT Presentation

Dr. Carol Burrell Skinnz Dermatology & Wellness Centre 3A Caledonia Rd, Mandeville, Tel 962-9346, 863-8832 30 Union Street Montego Bay ,Tel 979-9968, 398- 8349

Acne: Definition  Chronic inflammation of the pilosebaceous unit characterized by sebum retention.  Appears during puberty in people with seborrhoeic skin.  Predominantly on the face and to a lesser extent on the thorax, back, neck and shoulders (areas with the greatest number of sebaceous glands)  With little or no relation to food  Many types of lesions: papules, pustules, comedones, cysts, nodules, scars- depressed or hypertrophic

Acne Vulgaris Many types of lesions

Acne Vulgaris Many types of lesions

Acne Vulgaris Many types of lesions

Acne: Prevalence  Affects adolescents – 12-17 yrs.  40% of adolescents suffer from severe acne requiring treatment.  May disappear on its own.  May persist into the 20- 30’s.  Affects the sexes equally, but more severe in males, with earlier onset in females.  Potential to leave scars.

Acne: Aetiology (multifactorial) 1. Increased Sebum Production: Sebaceous gland stimulation resulting in growth and greater sebum production  Androgen dependent. 2. Poral Occlusion : skin pores clogged (sebaceous duct hyperkeratinisation). 3. Bacterial proliferation on the skin ( Propionibacterium acnes ). 4. Dermal Inflammation Immune response: Inflammation and erythema caused by inflammatory mediators. Genetics play an important role.

Acne: Treatment Combination therapy: 1. Increased Sebum Production: Anti-androgens, Retinoids 2. Poral Occlusion : Cleansing, Abrasive scrubs/cloths, Retinoids, comedone extraction, microdermabrasion 3. Bacterial proliferation on the skin: Antibiotics (Systemic and local ) 4. Dermal Inflammation: corticosteroids topical and intralesional into cysts

Current treatment options Topical  Oral Retinoids: Tretinoin, Adapalene, Isotretinoin, Benzoyl peroxide,  Antibiotics ( Tetracycline, Antibiotics (Clindamycin 1%, minocycline, doxycycline, Erithromycin 2%) erythromycin, TMP/SMZ) Azelaic acid  Isotretinoin Salicylic acid  Hormone therapy Combinations  Corticosteroids (BP + antibiotic Ret + Antibiotic), Glycolic acid Others Facials Chemical peels Microdermabrasion Phototherapy Filling Materials Surgery

Acne: Treatment goals  Reduce/eliminate comedones − Normalise/correct follicular keratinisation − Reduce glandular activity  Reduce/eliminate inflammatory lesions − Reduce P. acnes (bacterial population) − Reduce inflammatory response  Prevent sequelae − Minimise psychological effects − Minimise scars

Treatment – General Measures  Wash twice daily with warm water and soap – sulphur soap, triclosan, antibacterial soaps,  Scrubs – Two to Three times weekly  Do not manipulate the lesions  No special diets, maintain balanced diet, water , fruits and vegetables  Avoid any dietary aggravating factors  Keep hair clean

Treatment – Specific Measures  Topical agents :  BPO - 2.5%, 5%  Clindamycin – 1%, 2%  Erythromycin – 2%  BPO/Clindamycin combination  Retinoids – Tretinoin, Adapalene  Retinoid/ Antibiotic combination  Retinoid/BPO combination

Treatment – Specific Measures  Systemic agents :  Antibiotics – doxycycline, minocycline, azithromycin  Isotretinoin – must monitor liver enzymes and cholesterol. Does not cause liver damage. Teratogenic  Hormonal treatment – anti androgens – contraceptives, ciproterone acetate, spironolactone

Treatment – Specific Measures  Comedone Extraction  Intralesional corticosteroids  Microdermabrasion  Surgery – Scar excision, Subscision, Needling or Dermarolling  Phototherapy

Summary  Acne is a very common condition  Acne may persist into adulthood in certain patients (especially females)  Acne patients frequently experience physical as well as psychological problems  Early treatment is very important to control the disease and prevent the physical and emotional sequelae.

Thank You