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Acne Vulgaris
Acne Vulgaris
Acne Vulgaris
Introduction:
Definition:
Multi-factorial disease characterized by
abnormalities in sebum
production, follicular desquamation, bacterial
proliferation and
inflammation.
Prevalence:
85% adolescents experience it
Prevalence of comedones (lesions) in adolescents
approaches 100%
Overview
Acne vulgaris is the most common cutaneous disorder in
the many countries.
It affects more than 17 million Americans.
10 percent of all patient encounters with primary care
physicians.
Pts can experience significant psychological morbidity
and, rarely, mortality due to suicide.
Important that physicians are familiar with Acne Vulgaris
and its treatment.
Pathogenesis:
Acne vulgaris is a disease of
pilosebaceous follicles.
Factors:
Retention hyperkeratosis.
Propionibacterium acnes
within the follicle.
Inflammation
continue
As more cells and sebum are added, the
comedo becomes visible (whitehead) and is
called a closed comedo, is., its content do not
reach the surface of the skin. If plug enlarges
and protrudes from the orifice of the follicular
canal, it is called an Open comedo, its contents
open to the surface of the skin. The tip may
darken (blackhead) because of the accumulation
of melanin that is produced by the epithelial cells
of the follicular lining.
Pathogenesis
Sebaceous glands enlarge
Sebum production increases
Growth medium for P. Acnes
plugs provide anaerobic
Lipid-rich environment
Pathogenesis
Bacteria thrive
Inflammation results
Chemotactic factors attract neutrophils
Depending on conditions
Non-inflammatory
open/closed comedones
Inflammatory papule/
pustule/nodule
Terms/Definitions
Microcomedone:
closed comedo
(a whitehead):
Accumulation of sebum
converts a
microcomedo into this.
Inflammatory acne
Acne characterized by inflammation surrounding the
comedones, papules, pustules, and nodulocystic lesions. it
may cause permanent scarring.
Inflammatory acne begins in closed comedones, rarely in
open ones. As the micro comedo develops, it .distends the
follicle, which cause thinning of the walls. primary
inflammation of the follicle wall develops with the disruption
of the epithelium and infiltration of lymphocytes in to the
adjacent area of the dermis.
Normal sebum does not contain free fatty acids and is
nonirritating, however, in the presence of biolytic enzymes
produced by C.acne) , triglycerides of the sebum are split
and release fatty acids which are irritating to the tissue. Thus
sebum contribute to inflammation of the surrounding tissue.
The inflamed follicle or pustules either heal in about a week
or develop in to cyst or sterile abscesses, which can lead to
scaring.
Cysts
Cysts:
when follicles rupture into
surrounding tissues,
resulting in
papule/pustule/nodule.
Cysts
Aggravating factors
Change in sebaceous activity and hormonal
level (e.g. before or during premenstrual cycle)
High humidity conditions
Local irritation or friction
Rough or occlusive clothing
Cosmetics( having greasy base)
Diet; chocolate, nuts, fats colas, or
carbohydrates.?
Oils greases , or dyes in hair product.
ACTH
Azathioprine
Barbiturates
Isoniazid
Lithium
phenytoin
Disulfiram
Halogens
Iodides
Steroids
Cyclosporine
Vitamins B2,6,12
Clindamycin
Erythromycin
Tetracycline
Metronidazole
Azelaic acid
Oral isotretinoin
Reduces sebaceous gland size/sebum production
regulates cell proliferation and differentiation
Effect last 1 yr after cessation
Only med altering course of A. Vulgaris
Oral antibiotics
-Tetracycline
- minocycline
- doxycycline
- erythromycin
- TMP-SMX
- clindamycin
Patient FAQs
Soaps, detergents
remove sebum but do
not alter production
Avoid occlusive
clothing
Water based cosmetic
better than oil based
Diet modification no
role in rx
Acne conglobata
Unpleasant form of nodulocystic acne
Interconnecting abscesses and sinuses,
which result in unsightly hypertrophic (thick)
and atrophic (thin) scars.
There are groups of large macrocomedones
and cysts that are filled with smelly pus.
It is occasionally associated with hidradenitis
suppurativa,
Acne fulminans
Allergic reaction to P. acne
Abrupt onset
Inflammatory and ulcerated nodular acne
on chest and back
Severe acne scarring
Fluctuating fever
Painful joints
Malaise (ie. the patient feels unwell)
Loss of appetite and weight loss
Raised white blood cell count.