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Acne & Adnexal Disorders: Arief Budiyanto Bagian/ SMF IK Kulit Dan Kelamin FK-UGM/ RSUP Sardjito Yogyakarta
Acne & Adnexal Disorders: Arief Budiyanto Bagian/ SMF IK Kulit Dan Kelamin FK-UGM/ RSUP Sardjito Yogyakarta
Acne & Adnexal Disorders: Arief Budiyanto Bagian/ SMF IK Kulit Dan Kelamin FK-UGM/ RSUP Sardjito Yogyakarta
DISORDERS
Arief Budiyanto
Bagian/ SMF IK Kulit dan Kelamin
FK-UGM/ RSUP Sardjito
Yogyakarta
DISORDER OF ADNEXAL
ADOLESCENS SKIN
SEBACEOUS GLANDS
APOCRINE GLANDS
ECCRINE GLANDS
Acne vulgaris
Is it important or just
Trivial ?
Is it a disease ?
INSURANCE ?
Embarrasing
What is ACNE
Prevalence
( 85 %) mild
( 15 %) need medical treatment
PREVALENCE
-THE MOST COMMON VISIT DERMATOLOGIST AGE 15-45
-MAN > WOMAN ------- VISIT OF WOMEN 80% > FREQUENT
> AGE 19 YRS
-US DATA PRESCRIPTION ANTIBIOTICS $ 5 MILLION
ISOTRETINOIN $ 1.4 MILLION
PATHOGENESIS:
ANDROGE
N
5ar type 1
MICROCOMEDONE
Linoleic acid
IL-1 alpha
ABNORMAL KERATINIZATION
Acroinfundibulum
INFLAMMATION
RUPTURE FOLLICLE WALL
TNF
-ALPHA
P.ACNE
LIPASE
SEBUM SECRETION
DHT
STAPHYLOCOCCI, MICROCOCCI
GRAM (+), COAGULASE (-)
SUPERFICIAL AEROBIC
PORTION OF SEBACEOUS
UNIT
PITYROSPOSPORUM OVALE,
PITYROSPORUM ORBICULARE.
LIPOFILIC YEAST
PROPIONEBACTERIUM ACNES,
ANEROBIC PLEOMORHIC DIPHTEROID.
MOST PREVALENT ORGANISM IN
FOLLICULAR
INFRAINFUNDIBULUM
ANAEROBIC CONDITION
OF SEBACEOUS UNIT
INFLAMATORY
REACTION OCCURS IN
ACNE
PATHOGENESIS:
THE DEVELOPMENT
OF ACNE LESSION
MIKROCOMED
O
COMEDO
INFLAMMATION
LESSION
CLINICAL SIGN:
PRIMARY LESSION
COMEDO
1.OPEN
2.CLOSED
Sedang:
20-100 komedo, atau 1510 lesi inflamasi,
atau lesi total 30-125
18
19
ACNE VULGARIS
DEFINITION:
1. CHRONICALLY INFLAMMATION OF
SEBACEOUS FOLLICLE
2. LESSION COMEDONE-PAPULE-PUSTULENODULE-CYST-SCAR (PLEOMORPHIC)
3. PREDILECTION SEBORRHOIC AREA
4. AGE -PUBERTY
1. PREDILECTION
2. LESSION
3. SEBORRHOE
4. TEENAGE
CLINICAL VARIATION:
NEONATAL ACNE
ADULT ACNE
SUBTYPES OF ACNE:
CYSTIC ACNE
SUBTYPE ACNE :
ACNE FULMINAN
SUBTYPES ACNE:
MECHANICAL ACNE
ACNE COSMETICA POMADE ACNE
ACNE EXCORIEE
DIFFERENTIAL DIAGNOSIS:
ROSACEA
ERYTHEMATOTELANGIETATIC
PAPULOPUSTULAR
DIFFERENTIAL DIAGNOSIS:
PHYMATOUS
OCULAR
DIFFERENTIAL DIAGNOSIS
ACNEIFORM ERUPTION
* CORTICOSTEROID
* INH
* BROMIDE. IODIDE
* PHENYTOIN
DIFFERENTIAL DIAGNOSIS
PERIORAL DERMATITIS
DIFFERENTIAL DIAGNOSIS:
TREATMENT:
ANTI -ANDROGEN
ABNORMAL KERATINIZATION
RETINOIC ACID
INFLAMMATION
P.ACNE
ANTI INFLAMMATION
ANTIBIOTIK
SEBUM SECRETION
Actions of Anti-Acne
Therapies
Topical retinoids:
Normalize follicular
hyperproliferation
and cohesiveness
Reduce
inflammatory
response
Antibiotics:
Reduce
microorganisms
Reduce
inflammatory
response
Benzoyl
peroxide:
Reduces
Oral
Isotretinoin:
Reduces sebum
Normalizes
hyperkeratinizatio
n
Inhibits P. acnes
growth (indirect)
Reduces
inflammatory
response
Hormones:
Reduce sebum
production
Reduce
proliferation
of follicular
keratinocytes
CURRENT ACNE
TREATMENT
TOPICAL -RETINOIDS
-ANTIBIOTICS : CLINDAMYCIN, ERYTHROMYCIN,
NADIFLOXACIN, NA
SULFACETAMIDE,
DAPSONE
-BENZOYL PEROXIDE
-AZELAIC ACID
-SALICYLIC ACID, SULFUR
-NICOTINAMIDE, ASCORBIC ACID
SYSTEMIC -ANTIBIOTICS
-HORMONAL
-ISOTRETINOIN
ADJUVANT -CHEMICAL PEELING
-LASER & LIGHT
-CRYO THERAPY
-DIET
Therapies
Actions of Anti-Acne
Therapies
HyperSebum
Inflammati Reduction
keratinizati
production on
Topical therapies
on
in P.acnes
Retinoids
++
Benzyl
peroxide
++
+++
Antibiotics
++
+++
Azelaic acid
+/-
Nicotinamide
+/-
Systemic therapies
Antibiotics
+++
+++
Hormonal
therapy
++
++
Indirect
Indirect
Retinoids
+++
++
++
++
Layton AM. A review on the treatment of acne vulgaris. Int. J. Clin. Pract. 60(1), 6472 (2006).
TREATMENT:
NON INFLAMMATION
TOPICAL
KERATOLYTIC
COMEDOLYTIC
BACTERICIDAL
TREATMENT:
INFLAMMATION
TOPICAL
= ACNE NONINFLAMMATION
BENZOIL PEROKSIDE
ANTIBIOTIC
SYSTEMIC
ANTIBIOTIC
ANTI INFLAMMATION
HORMON
RingkasanManajemen
Acne
Tujuan Pengobatan
Ringkasan Manajemen
Acne
Prinsip penatalaksanaan
1. Pencegahan
2. Pengobatan
Topikal
Sistemik
Kombinasi topikal & sistemik
Tindakan khusus
3. Perawatan
45
PERTIMBANGAN KLINIS
BROMHIDROSIS
APOCRINE
ECCRINE
BROMHIDROSIS
EXCESSIVE ABNORMAL BODY ODOR
FOUL SMELLING SWEAT-MALODOR
ARISE FROM THE APOCRINE GLAND
BROMHIDROSIS
YOUNG ADULTS
BLACK
SUMMER
FAMILY HISTORY
CULTURAL
SUBJECTIVE -RACES
BROMHIDROSIS PATHOGENESIS
PREDISPOSING FACTOR
HYPERHYDROSIS
OBESITY
INTERTRIGO
DIABETES MELLITUS
FOODS - GARLIC
- ALCOHOL
HERITABLE AMINOACIDURIA
BROMHIDROSIS TREATMENT
ANTIPERSPIRANT
Aluminum chloride hexahydrate
Aluminum chlorhydrate
Aluminum sesquichlorohydrate
Aluminum chlorohydrex
Aluminum zirconium tetrachlorohydrate
Formaldehyde 10%
Glutaraldehyde 10%
Methenamine 8%
Glycopyrrolate
DEODORANT
Triclosan
Benzalkonium chloride,
Chlorhexidine.
Propylene glycol
Fragrances