Acne

- A physical change in the skin caused by a disease process in the sebaceous follicle

- Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms

Types of Acne

Comedo, papule, pustule, nodule and cyst.

Sebaceous glands: Glands in the skin that produce an oily substance called sebum--these glands are the sites of acne lesions. Sebaceous glands are attached to hair follicles and are found mostly on the face, neck, back and chest.

Sebum: The oily substance produced by sebaceous glands.

Classification of Acne Vulgaris Obstructive Acne

Open Comedones (Black heads) Closed Comedones (White heads)

Inflammatory Acne (in order of lesion formation) Papules Pustules Nodules Cysts Scars

Acne occurs when androgen hormones cause sebaceous glands to grow and produce more sebum. In concert with this change, there are changes in the skin lining the hair follicle to which sebaceous glands are attached. The skin cells of the follicle lining shed more quickly, in clumps, and are sticky. These cells and increased sebum output are likely to cause clogged pores that can become comedones. Finally, a kind of bacteria, P. acnes, which is a normal resident on the skin, invades the clogged follicle and begins to multiply rapidly. The result is acne in all its forms.

Mechanism

Drugs used in Acne Isotretinoin

Azelaic Acid Clindamycin Topical Erythromycin Topical Tetracycline Topical Benzoyl Peroxide Tretinoin

Given the way acne occurs, acne treatments do one or more of the following: •Reduce sebum production •Reduce P. acnes •Normalize the shedding of skin cells

Acne Treatment

IsotretinoinIndications

Acne VulgarisDosing

Course: 15-20 weeks Facial Acne

Lower dosing: 1 mg/kg divided bid) Truncal Acne

Higher dosing: 2 mg/kg divided bid Consider repeat 4 month course after 2 month rest

Indicated for severe, refractory truncal acne Adverse Effects

Very Teratogenic (even 1 pill) Needs two forms Contraception while taking Counsel extensively before use

Cheilitis (90%) Dry or chapped skin (90%)

Dry nose and eyes (80%) Elevated serum Triglycerides (25%) Elevated liver transaminases (15%) Hair shedding (10%) Night blindness

Monitoring Serum testing baseline and every 2-4 weeks

Liver transaminases Triglycerides

Benzoyl PeroxideIndication

Acne Vulgaris Mechanism

Comedolytic Kills follicular bacteria Resistance cannot develop

Preparations Pure

Cream 5%, 10% Gel 2.5%, 5%, 10% Lotion 5%, 10%

Combination Benzoyl peroxide with Erythromycin (Benzamycin)

Gel 50 mg benzoyl peroxide and 30 mg Erythromycin

Application Apply to clean skin each day for 3 days Slowly increase strength of application Later increase time left on skin

Adverse Effects May cause skin dryness or irritation

Use water based instead of acetone or alcohol product Use Lotion or cream instead of gel

Bleaches hair and skin