Transcript ACNE Definition - New York Medical College

ACNE
Definition
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Inflammation of sebaceous follicles
Follicle
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sebaceous gland
follicular canal
hair
ACNE
Classification
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comedonal acne
mild inflammatory acne
moderate inflammatory acne
severe inflammatory (nodulocystic)
ACNE
Pathogenesis
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Pubertal changes
increased sebaceous production of sebum
abnormal sloughing of follicular wall lining
closed comedone (whitehead)
open comedone (blackhead)
ACNE
Pathogenesis
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Accumulation of Propionobacterium acnes
(normal skin flora)
metabolization of sebum release of free fatty
acids
attraction of neutrophils  rupture of follicular
wall extrusion into the dermis
inflammatory lesions
 papules, pustules
 nodules, cysts
Acne
lesions at a glance
ACNE
Lesions
Inflammatory and comedonal
acne
ACNE
Lesions
Open comedones are evident on
the chin
ACNE
Lesions
inflammatory and comedonal acne
ACNE
Therapy (Mechanisms)
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Hormonal regulation
Sebum suppression
Keratolysis and inhibition of follicular
proliferation
Antibacterial / antiinflammatory
Hormonal regulation
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Oral contraceptives
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particularly estrogen predominant
Ortho-Tri-Cyclen
Spironolactone
Sebum suppression
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Isotretinoin (Accutane)
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oral synthetic Vitamin A analog
shrinks sebaceous gland
Keratolysis and inhibition of
follicular proliferation
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OTC preparations
 salicylic acid (Stridex)
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Benzoyl Peroxide
Isotretinoin (Accutane)
Topical retinoids
 tretinoin (Retin-A)
 adapalene (Differin)
 tazarotene (Tazorac)
Azelaic Acid (Azelex)
ACNE
Topical retinoids
Contemporary Peds Dec. 2000
ACNE
Adapalene (Differin)
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Derivative of Naphthoic acid
Has more specific retinoid receptor
activity
Some studies have shown less irritation
ACNE
Azelaic Acid (Azelex)
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Dicarboxylic acid produced by P. ovale
demonstrated activity against P. acne
demonstrated ability to inhibit
microcomedo
Prevents hyperpigmentation
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inhibits tyrosinase (melanin synthesis)
adresses postinflammatory
hyperpigmentation
Antibacterial / antiinflammatory
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Topical
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Erythromycin
Clindamycin
Oral
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Tetracycline
Doxycycline
Minocycline
Erythromycin
ACNE
Topical antibiotics
Contemporary Peds Dec. 2000
ACNE
Oral Antibiotics
Contemporary Peds Dec. 2000
ACNE
therapy (vehicle effects efficacy)
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Creams
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Less potent than gels
Less drying than gels
May not be good for
the patient with oily
complexion
Gels, solutions
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more drying
tend to cause more
irritation
oily skin
ACNE
Counseling
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Poor hygiene is not a cause of acne
Effect of diet has not been demonstrated
4 – 6 weeks of treatment before any
improvement is expected
Warn patients about skin irritation
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BP, topical retinoids
Warn patients about photosensitivity
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topical retinoids, tetracycline, Doxycycine
apply at night
consider noncomedogenic sunscreen (SPF =15)
ACNE
Counseling II
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Apply topical therapy to entire region not just to
lesion
Start at low dose, infrequent applications and
increase gradually
Apply to thoroughly dried skin
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30 minutes of air-drying
not right after washing your face
Avoid cosmetics, mechanical friction
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harsh scrubbing
tight chin straps, caps
bangs
ACNE
Treatment Plans
ACNE
Treatment Plans
ACNE
Treatment Plans
Consultant April 1999
ACNE
When to refer
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No improvement despite therapy
Cysts or scars
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sometimes require intralesional steroids
Consideration of Accutane or
spironolactone
Associated menstrual irregularity or
hirsutism
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polycystic ovarian syndrome
ACNE
Treatment Plans
ACNE
Treatment Plans
Contemporary Peds Dec. 2000
ACNE
Treatment Plans
ACNE
Treatment Plans
Contemporary Peds Dec 2000
ACNE
Treatment Plans
ACNE
Treatment Plans
Contemporary Peds Dec 2000
ACNE
References (required reading)
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Pediatric Clinics North America
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Contemporary Pediatrics
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August 2000
Dec 2000
Pediatric Annals
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January 2000
Available in the Peds Office