ACNE

Breif Review

Acne Vulgaris - Treatment Based on Pathogenesis

• A disease of the pilosebaceous unit of the skin• start appearing in adolecence• Pathogenesis is multifactorial • It causes social, and psychological quality of life

impairment

Pathogenesis of Acne

• Abnormal follicular keratinization• More sebum production• Proliferation of Propionobacterium acnes• Hormonal factors• Host immune response

Primary Lesions of Acne

• Closed comedones

• Open comedones

• Red papules

• Pustules

• Nodules or some times Cysts

• Scars

Primary Lesions of Acne

• Closed comedo

• Open comedo

• Red papule

• Pustule

• Nodule or Cyst

• Scar

•Acne in 4th and 5th Grade Girls is

Correlated with increased DHEAS during adrenarche

The Comedo

keratinaceous debris, that blocks the orifice of pilocebaceous unit

Acne Therapies Principles

• Correct altered follicular keratinization

• Modulate host immune response

• Reduce sebum production

• Decrease androgenic effects

• Inhibit the growth of P. acnes

Acne Treatments

• For comedonal lesions - topical retinoids– Tretinoin (Retin-A)

– Adapalene (Differin)

– Tazarotene (Tazorac)

• Add benzoyl peroxide 2.5% to 5% if few papules are present too. (Bleaches clothes)

• Or add azelaic acid

Systemic therapies for acne

– Isotretinoin (Accutane™, Sotret etc.)– DHEAS, free testosterone, 17 OH-P– Ortho Tri-cyclen, Yasmin, Allese– Spironolactone