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

Retinoids: Tretinoin, Adapalene, Isotretinoin, Benzoyl peroxide, Antibiotics (Clindamycin 1%, Erithromycin 2%) Azelaic acid Salicylic acid Combinations (BP + antibiotic Ret + Antibiotic), Glycolic acid

Oral



Antibiotics ( Tetracycline, minocycline, doxycycline, erythromycin, TMP/SMZ)



Isotretinoin



Hormone therapy



Corticosteroids

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