Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne in Adolescents

Precious Teens Precious LivesPresidential Action Plan 2018-19

Objectives

• To discuss pathophysiology of acne

• To outline management of adolescent acne

Precious Teens Precious LivesPresidential Action Plan 2018-19

Epidemiology and Importance

• 90% of adolescents , all races , both sexes• Family history is often positive • Typically presents at 12-14 , peaks at 15-18, and

resolves by age 25• Face, neck and upper trunk • Menstrual acne 7-10 days before onset of periods ;

stops with onset• Acne –low body image-low self esteem – depression-

anxiety – social phobia - significant negative psychological effect -suicide

Precious Teens Precious LivesPresidential Action Plan 2018-19

Precious Teens Precious LivesPresidential Action Plan 2018-19

Case Gulnaz , 15-year-old teenager presents with “pimples” on her face for the last 2 years. She has a daily routine of aggressive facial cleansing with a bar soap during her morning shower.

• Past History: No chronic illnesses / hospitalisation

• Allergies: None • Medications: None • Family history: Both parents had acne

as teens • Social history: High school student

Any other history ?

Precious Teens Precious LivesPresidential Action Plan 2018-19

HEEADSSS

• Home: lives with parents , both parents had

acne as teenagers

• Education: High school student

• Eating: Eats a balanced diet

• Activities: Avoids moving out

with friends

• Drugs: No smoking / alcohol/ drugs

• Sex: Never been sexually active

• Suicide: No history of depression

Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne Classification

How do we grade acne ?

Precious Teens Precious LivesPresidential Action Plan 2018-19

Grades of Acne

Grade I: Comedones (open or closed), occasionally pustules or papules (10); no scarring.

Grade II: comedones, Papules, few pustules (10-40); mild scarring.

Grade III: Predominant pustules (40-100), nodules, abscesses; moderate scarring.

Grade IV: Mainly cysts, abscesses, scars; severe scarring.

Precious Teens Precious LivesPresidential Action Plan 2018-19

Pathogenesis of Acne

Breaks sebum to highly irritating free fatty acids

Inflammation

Inflammatory acne -lipase

Obstructing plug prevents sebum reaching the skin surface

P. acnes colonizes the pilosebaceous duct

Increased level of circulating androgens Stimulation of sebum production

Anatomy and Physiology of skin Microcomedone

Closed comedone (whitehead) Open comedone (blackhead)

Precious Teens Precious LivesPresidential Action Plan 2018-19

Acne with Hirsutism and Alopecia

What would you consider as differential diagnosis ?

Precious Teens Precious LivesPresidential Action Plan 2018-19

Treatment

• Diet

• Skin care

• Topical Therapy

• Systemic Therapy

• Laser and cosmetic therapy

• Counselling

Precious Teens Precious LivesPresidential Action Plan 2018-19

Skin CareBasic skin care

No vigorous washing, scrubbing or picking

Cleanse with a gentle soap containing salicylic acid, glycolic acid or benzoyl peroxide

Use noncomedogenic moisturiser, if needed

Based on skin type, choose appropriate vehicle for topical treatments Oily (solutions, gels, pledgets , no moisturizers)

Combination (lotions)

Dry (cream, ointment)

Precious Teens Precious LivesPresidential Action Plan 2018-19

Topical Therapy

• Benzoyl peroxide

• Azaleic acid

• Salicylic acid and alphahydroxy acids

• Retinoids (Adapalene)

• Topical antibiotics : Clindamycin(1-2%) and erythromycin(2-4%)

Precious Teens Precious LivesPresidential Action Plan 2018-19

Systemic Treatment

Systemic treatments : when topicals as monotherapy are ineffective

First Line:

Doxycycline 50 mg daily /Minocycline 50 mg BD

Second Line :

Erythromycin 250-400 mg once or twice daily

Azithromycin 500 mg

Clarithromycin 250 mg

TMS 80-400 mg once or twice daily

Combined Oral Contraceptives

Precious Teens Precious LivesPresidential Action Plan 2018-19

Key Messages

• Acne is commonly seen in adolescence

• Acne occurs due to excessive proliferation of follicular keratinocytes because of increased levels of circulating androgen

• Psychological effects of acne should be assessed and managed carefully in each case

• The treatment includes: Topical Therapy , Systemic Therapy , Skin care , Balanced diet

Precious Teens Precious LivesPresidential Action Plan 2018-19

ContributorsMission Kishore Uday 2018-19

• Dr Preeti M Galagali

• Dr Atul M Kanikar

• Dr Sushma P Desai

• Dr Chitra Dinakar

• Dr Latha R

• Dr Sandip K Trivedi

• Dr Harmesh S Bains

• Dr Somashekar AR

• Dr Sarala Premkumar

• Dr Poongodi Bala