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7/23/2019 Acne Psoriasis Fisiopatologia
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ACNE
FISIOPATOLOGIAMg RUBEN TORRES CORREA
FM UNP2015
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ACNE: Introducc!n
A" #ULGARIS:ES UNA ENFERME$A$
MULTIFACTORIALINFLAMATORIA
CRONICA $E LA PIEL% &u' ('d'()rro**) )*r'd'dor d'*
APARATO PILOSEBACEO + ('
,)n-'(t) co,o COME$ONESA.'rto( + C'rr)do(% t),./n co,oPAPULASIn),)tor)(%
PUSTULAS + NO$ULOS"
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Introduccon 2
Lo( (to( co,n,'nt'co,ro,'tdo( (on: CARA% PEC3O%$ORSO ALTO% + MIEMBROS
SUPERIORES"
E* Acn/ In),)toro u'd' r'(u*t)r'n CICATRICESot'nc)*,'nt'
d'(-gur)nt'( ' 3IPERPIGMENTACIONPOST INFLAMATORIA
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PATOGENESIS d'* ACNE
Co,'n4) con *) ERATINI6ACIONANORMAL &u' c)u() IMPACTACION +$ISTENSION d' *) orc!n .)7) d'*
INFUN$IBULUM 8or,)ndo '*COME$ON"
OTROS FACTORES nc*u+'n un)
r'*)c!n co,*'7) 'ntr'PRO$UCCION
SEBACEA% con c),.o( 'n *)
co,o(c!n *9dc)%
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PATOGENESIS 2
3'r('n(.*d)d )* '(t9,u*o d'AN$ROGENOS
PROPIONIBACTERIUM ACNES +
CITOINAS INFLAMATORIAS'*).or)d)( or '* SISTEMA INMUNEINNATO S"I"I";
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3IPERERATINI6ACION
R'(u*t) d' 3'rro*8'r)c!n 't'*)* 8o*cu*)r+ R't'nc!n d'
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3'r
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Anor,)*d)d'( d'* S'.o
L) roducc!n d'* ('.o '( n'c'()r) 'rono (u-c'nt' )r) *) )tog/n'(( d'*)cn/% + *) co,o(c!n d' *o( *9do(
('.?c'o( u'd' nu'nc)r *) n),)c!n" A*t'r)con'( 'n *) co,o(c!n d' *9do(
d'* ('.o t)*'( co,o d'()tur)c!n)u,'nt)d) d' ?cdo( gr)(o( *.r'(%
'(cu)*'no + 'r!=do d' '(cu)*'no% on>'*'( r'ducdo( d' ?cdo *no*'co; )n(do )(oc)do( con@
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Anor,)*d)d'( d'* ('.o 2
@'rcorn-c)c!n 8o*cu*)r or,odu*)c!n dr'ct) ' ndr'ct) d'*S"I"I"
Producto( d' 'ro=d)c!n d' *9do(u'd'n )u,'nt)r *)( cto
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Anor,)*d)d'( d'* ('.o D
@*o cu)* ro,u'>' *) con>'r(!n d'?cdo )r)&ud!nco ) L'ucotr'no B+ r'c*ut),'nto (u.('cu'nt' d'
c/*u*)( >) PPAR " E(t)( )ct>)n *)(c/*u*)( T) tr)>/( d'* )ct>)dor d'rot'n)( 1 AP1; + *) r'gu*)c!n
tr)n(crcon)* ,'d)d) or '* 8)ctornuc*')r d' c)d'n) *g'r) )d)(
NFB;"
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Anor,)*d)d'( d'* S'.o
L) n),)c!n ,'d)d) or '* ('.o '(t?und) ) *) ro*8'r)c!n d'* P" )cn'(" L)(g*?ndu*)( ('.?c')( + *o( *9do( d'* ('.o
ro>''n un ,)rco )n)'r!.co )* cr'c,'ntod'* P" )cn'(" Co,o '* ('.o )() or '* ducto8o*cu*)r% *)( *)()(roducd)( or P" )cn'(dro*4)ntrg*c/rdo( ) ?cdo( gr)(o( *.r'(
ro n),)toro(" E* P" )cn'( t),./n (' un') TLR2 + TLR (o.r' *)( g*?ndu*)( ('.?c')()r)
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Anor,)*d)d'( d'* ('.o 5
@'(t,u*)r *) roducc!n ('.oc9tc)d' /tdo( )nt,cro.)no( 3H$1 +3H$2; + cto)con'( (ug'r'n un ro* d' *)(g*?ndu*)( ('.?c')( 'n *) )tog'n)
r'conocd) + '(t,u*)c!n d'* S"I"I"
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AN$ROGENOS EN ACNE
Producdo( 'n gr)n c)ntd)d org*?ndu*)()dr'n)*'( + g!n)d)( +t),./n *oc)*,'nt' d'ntro d' *)(
g*?ndu*)( ('.?c')(% dond'ro,u'>'n *) ro*8'r)c!n d'
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Andr!g'no( 'n Acn' 2
L) u.'rt)d ) (do )(oc)d) con '*co,'n4o d' )cn/ >u*g)r(% con '*)u,'nto d' )ndr!g'no( dur)nt'
'(t' 'r9odo &u' '(t,u*) *)roducc!n d' ('.o ) tr)>/( d' *)un!n d' r'c'tor'( 'n *)( g*?ndu*)(
('.?c')( + conducto( *o('.?c'o("L) '* ro'n() )* )cn/ t'n' n>'*'(,?( )*to( d' r'c'tor'( d'
)ndr!g'no( + )ct>d)d )u,'nt)d)
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Andr!g'no( 'n )cn/ D
C*9nc),'nt'% *o( )c'nt'( con Sdd' O>)ro Po*&u9(tco% 3'r*)())dr'n)* cong/nt) + Tu,or'(
or,on)*'( '(t)do( d' '=c'(o d')ndr!g'no(; t'n'n gr)do( ,?( )*to(d' )cn/% ,'ntr)( )&u'**o( con
d'-c'nc) o n('n(.*d)d ) *o()ndr!g'no(no t'nd'n ) d'()rro**)r)cn/"
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Andr!g'no( 'n )cn/
Lo( )ndr!g'no( t),./n ro,u'>'n*) co,'dog/n'(( ) tr)>/( d' *)r'gu*)c!n d' 8)ctor'( d'
cr'c,'nto ' IL1 % *o( cu)*'('(t,u*)n *) 'r
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PROPIONIBACTERIUMACNES
E( un .)c*o GJ &u' (' d'()rro**) 'n '*,'do )n)'r!.co d'* ))r)to *o('.?c'oK'(t' co,'n()* ro>oc) r'(u'(t)(
n),)tor)( &u' conduc'n ) *))tog/n'(( d'* )cn/"
S'cr't) *)()(&u' dg'r'n *o(trg*c/rdo( d'* ('.o ) ?cdo( gr)(o( *.r'(
&u' '(t,u*)n /tdo( )nt,cro.)no(3H$1 + 2% c)t'*cdn) + gr)nu*cn); +r'(u'(t)( n),)tor)( (gu'nt'("
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Proon.)ct'ru, )cn'( 2
Atr)' dr'ct),'nt' TLR2 + TLR'ncontr)do( 'n *o( /( d' IL; + ,)cr!8)go()*
8o*9cu*o" L) con(gu'nt' r'(u'(t)n),)tor) c)u() rutur) d' *))r'd 8o*cu*)r"Lo( ,)cr!8)go(
ro)g)n '* cc*o or *.'r)c!n d'
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Proon.)ct'ru, )cn'( D
@or r'(u'(t) d' c/*u*)( T1;" L)(cto)n ) d'(trucc!n t(u*)r +8or,)c!n d' '(c)r)(" TLR( t),./n
u'd'n '(t,u*)r *) '=r'(!n d'/tdo( )nt,cro.)no("
P")" ro,u'>' 'r
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Proon.)ct'ru, )cn'(
@nducr nt'grn)( rot'n) d' )d'(!nc'*u*)r; + -*)grn)'ncontr)d) 'n )*t)(conc'ntr)con'( 'n '* n8und.u*u, +
conducto ('.?c'o d' '* )cn' ron);" E* Bo-*, o*()c?rdo d' r'>'(t,
roducdo or P")" &u' rod') *o( ,cro.o(+ ,'7or) (u )d'r'nc) )* 8o*9cu*o; )d',?(
ro,u'>' *) 'r
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INMUNI$A$ INNATA
E* S"I"I" r'(u'(t) r?d) (n,',or) ) )t!g'no( '('c9-co(; '(*) >'rd)d'r) r)4!n d' *) .)('
n),)tor) d' *) )tog/n'(( d'*)cn/" A tr)>/( d' *) .)rr'r) 89(c) +)cd'4 d'* '(tr)to c!rn'o &u'
*,t)n *) co*on4)c!n .)ct'r)n); *)'*ro>'' d'8'n() d' 1r) *9n')d'ntro d'* S"I"I"L) '* t),./n
'*).or) 8)ctor'( (o*u.*'( & nc*u+'n
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In,und)d nn)t) 2
@&u,o
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INFLAMACION,'d)d) orS"I"I"
L) n),)c!n nc) + ro)g) *))tog/n'(( d'* )cn/" L) IL1'( *)cto
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In),)c!n ,'d)d) orS"I"I"2
L) ('cr'c!n d' IL1 or *o(
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In),)c!n ,'d)d) orS"I"I"D
@*) d') &u' un ,'do),.'nt'n),)toro '( n'c'()ro )r) *))tog/n'(( d'* )cn/ + &u' '* roc'(o '( IL
1 '('c9-co" L) IL18o*cu*)r '(t,u*) *)( c/*u*)( &u'
rod')n '* 'ndot'*o >)(cu*)r ) '*).or)r,)rc)dor'( n),)toro( )dcon)*'(
('*'ctn)E% ,o*/cu*)1 d' )d'(!n d'c/*u*)( >)(cu*)r'(% ,o*1 d' )d'(!n nt'rc'*u*)r + )nt9g'no *'ucoct)ro u,)no$R;"
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Figure 1.
Propionibacterium acnes,'d)t'( )cn'
)tog'n'(( troug nn)t' ,,un')ct>)ton"AP)ct>)tor rot'n% FFA8r''8)tt+ )cd% ILnt'r*'u
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R'8'r'nc) ..*ogr?-c)
Shinjita Das, Rachel V. Reynolds.R'c'nt Ad>)nc'( n Acn'Ptog'n'((" A, C*n $'r,)to*"201K 15;:
",'d(c)'"co,"
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PSORIASIS" FISIOPATOLOGIA
FM3 UNP2015
Mg" Ru./n Torr'( Corr')
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P(or)((" F(o)to*og9)"Introducc!n
L) P(or)(( >u*g)r '( un)'n8'r,'d)d n),)tor) cr!nc)%n,uno,'d)d)% cu+o 8'noto d'
r'('nt)c!n ,?( co,n (',)n-'(t) 'n *o( nd>duo()8'ct)do(% co,o *)c)( d/r,c)(
'(c),o()( + 'rt',)to()(" L)(*'(on'( rurgno()( + )">"do*oro()(% c)u()n d(,nuc!n
(gn-c)t>) 'n *o( (cor'( d' c)*d)d
P F t * 9
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P(" F(o)to*og9)"Introducc!n 2
Su r'>)*'nc) (' '(t,) 'ntr' 2DQUS;K '( un) d' *)( 'n8'r,'d)d'(d'r,)to*!gc)( ,?( co,un'(% con
J 1"5 ,**on'( d' P( ,od'r)d) )('>'r)" Ad',?(% (ug'r'nc)(r'c'nt'( '(t,)n &u' D0Q d'
(or?(co( u'd'n t'n'r t),./nArtrt( P("% *) &u' 'n (u 8or,) ,?(('>'r) u'd' conducr ) d)o
)rtcu*)r 'r,)n'nt' + ('r
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P(" F(o)to*og9)"In,uno)tog/n'(("
Uno d' *o( ,?( r'c'nt'( + t)*>'4 d'()rro**o,?( ro,(oro 'n *) n>'(tg)c!n d' *) P(% '('* ro* d' *)( c/*u*)( T C$T1 + un) d' (u(cto
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P(" In,uno)tog/n'(( 2
@roducrTNF% IL1H ' IFN% ' IL'n nd>duo( g'n/tc),'nt'(u(c't.*'("
E(to ) (u >'4 )ct>) ) *)( c/*u*)(,'*od'( d'ndr9tc)(*oc)*'( ) roducrIL2D% *) cu)* )r'c' ('r *) cto' 'n>u'*t) 'n *) d8'r'nc)c!n +'(t).*4)c!n d' *)( c/*u*)(T1"
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P(" In,uno)tog/n'(( D
L)( c/*u*)(T1d8'r'nc)d)(%,gr)n )c) d'ntro d' *) 'd'r,(contro*)d) or nt'grn) 1H1; +
roduc' (u.('cu'nt','nt' IL22 +('( cto
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P(" In,uno)tog/n'((
@)u,'nt)d) d'
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P(" In,uno)tog/n'(( 5
E(tudo( t',r)no( o(t>o(ro.)ron *) '-c)c) d'* .*o&u'o d'IL1'n 'n8'r,'d)d'( n),)tor)(
c*)>' (,*)r'( ) *) P("
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R'8'r'nc) ..*ogr?-c)
Steven M Nwe, Amanda !ham"lain, #enneth $ %ordon.R)ton)*' )nd E)r*+ C*nc)* $)t) onIL1 B*oc