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Guidelines_English_Final
تحميل الدليل التدريبي

أسئلة شائعة


 

ACNE
AND ACNE RELATED DISORDERS

Dr. Sami N. Al-Suwaidan

Assistant Professor and Consultant Dermatologist

Department of Dermatology

College of Medicine, KSU

 

 

          ACNE VULGARIS

          Acne vulgaris is the most common disease involving the pilosebaceous unit

          80-90 % of all adolescents will have some type of acne

          Primarily a disease of adolescence

 

“ALTHOUGH MEDICALLY BENIGN, ACNE IS COSMETICALLY AND PSYCHOSOCIALLY  MALIGNANT”

 

          Clinical Features:

          The lesions of acne are polymorphic

          Clinical lesions:

        Comedones

        Papules

        Pustules

        Nodules

        Cysts

          Clinical Features

          Types of Clinical lesions:

A.      Non-inflammatory

B.      Inflammatory

  1. Non-inflammatory lesions:
      • Open comedones (blackheads)
      • Closed comedones (whiteheads)            
  2. Inflammatory lesions:
      • Superficial inflammatory lesions
          • Papules
          • Pustules
      • Deep inflammatory lesions
          • Nodules
          • Cysts

SEVERITY GRADES

          Mild:                      comedones or papules with a                                    few pustules (or both)                                                  predominate

          Moderate:          papules(++) &pustules(++)

          Severe:                                nodules and cysts

 

ACNE SEQUELAE:

          Post inflammatory hyperpigmentation

          Post inflammatory hypopigmentation

          SCARS

 

ACNE SCARS:

          The most devastating complication

          Can be severe and disfiguring

          Graded into mild, moderate and severe

          The most common is the ice-pick type

          Difficult to treat

          Clinical Features

          Distribution:

          There is a wide range of individual clinical expression with males tending to have more severe forms

          The incidence is similar in males and females until the mid 20s

          ACNE VULGARIS

 

DIAGNOSIS?

          Etiology & Pathogenesis

          Increased sebum excretion rate

          Ductal hypercornification

          Colonization with P. acnes

          Production of inflammation

 

MANAGEMENT:

          There is no single best mode of therapy for all acne lesions

          Selection of therapy depends on three factors:

1.       The type of lesion

2.       The acne severity

3.       The psychological impact of the disease

          Important considerations when prescribing acne treatment

          Duration of disease

          Response to previous therapy

          Tendency for scarring

          Current medical condition

          Current medications

          Other considerations

 

ACNE  TREATMENT LINES

    1. Topical agents
    2. Systemic agents
    3. Isotretinoin

          Topical agents

        Tretinoin (Retin-A)

        Benzoyl peroxide

        Topical antibiotics (erythromycin, Clindamycin)

          Systemic agents

        Systemic Antibiotics:

          Tetracycline

          Minocycline

          Doxycycline

        Oral contraceptive pills

Isotretinoin:

o        Vitamine A derivative

o        Action:

Ø  Decreases sebum production

Ø  Normalizes keratinization

Ø  Decreases inflammation

Ø  Decreases P. acnes concentrate

 

Isotretinoin:

o        Indications:

o        Severe nodulocystic acne

o        Refractory moderate acne

o        Tendency for scarring

o        Dose:    0.5-1 mg/kg/day (cumulative dose)

o        A/E:

o        Strong teratogen            

o        Dryness, chelitis, increases TG &Chol, Increases liver enzymes, arthralgia, depression,etc

o        Requires medical supervision & periodical labs

          Therapeutic Approach

q  Mild acne (comedonal)

q  Tretinoin

q  Mild acne (predominantely inflammatory)

q  Topical antibiotic -/+ Tretinoin

          Therapeutic Approach

q  Moderate to severe

q  Systemic -/+ Tretinoin

q  Severe recalcitrant acne

q  Isotretinoin

 

 

OTHER VARIANTS OF  ACNE

         Acne conglobata:

q  Is a severe form of acne involving the face, upper trunk and characterized by multiple deep nodulocystic lesions with draining sinuses and grouped comedones

q  Irregular scarring and tissue necrosis occur

 

         Acne fulminans:

          Is an inflammatory ulcerative type of acne conglobata, affecting especially the trunk and associated with fever, generalized malaise, polyarthropathy, anorexia and weight loss.

          Most pts are boys aged 13-18 yrs who usually have mild acne and suddenly developed severe inflammatory acne and other symptoms within a few weeks.

          Drug Induced Acne

          Is seen with:

q  Androgenic hormones

q  Oral and topical corticosteroids

q  Anabolic steroids

q  Barbiturate

q  Anti-convulsants

         Steroid Acne:

q  Small monomorphic erythematous papules and pustules

q  Distributed mainly on upper trunk and arms

 

ROSACEA

o        Rosacea is a multiphasic disease characterized by four stages of pathologic events.

o        Age of onset:                     40-60 years

          ROSACEA

Clinical features:

  1. Clinical stages:

o        Stage I: transient flushing

o        Stage II:                persistent erythema &telangiectasia

o        Stage III:              acne rosacea

o        Stage IV:              rhinophyma

  1. Eye involvement:           

                                                Blepharitis, conjunctival hyperemia

Management:

  • Flushing:                              avoidance of stimuli
  • Erythema/                          LASER

                Telangiectasia:

  • Acne rosacea:                    topical metronidazole
  • Rhinophyma:                     surgical 

 

PERIORAL DERMATITIS

                Distinctive eruption occuring predominantely

                in young women

o        Sites:                     chin, nasolabial folds & upper lip

o        Morphology:     small skin colored papules and                 papulopustules

o        Etiology:              unknown                                                                                                                                                             ?chronic use of topical steroids

o        Treatment:                                                                                                                                                         1) gradual tapering of topical steroids

                                2) Topical/systemic antibiotics

 
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