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18th October 2012 - Acne

 The acne disease pathway
1
Androgen Sebaceous glands Excessive sebum
hormone enlarge production
influences and
stimulates Over production of Hyperkeratinization
sebaceous gland epithelial cells lining
follicles 2
Microcomedone
formation
A thick
hyperkeratotic plug
Scars
3
Inflammation and
Formation of pustules immune response
and cysts
Propionibacterium
acnes colonization in
Pathogenic factors of acne anaerobic environment
1. Excessive sebum production 4
2. Hyperkeratinization (abnormal cell turnover)
3. Inflammation and immune response White heads and
black heads form
4. P. acnes colonization
Goal of treatment: To target as many pathogenic
factors of acne as possible
 Actions of Anti-Acne Therapies
Topical retinoids Benzoyl
and naphthoic acid peroxide:
derivatives:  Kills
 Normalize desquamation microorganisms
 Keratolytic

Oral Isotretinoin:
 Reduces sebum
 Normalizes
desquamation
 Inhibits P acnes
 Reduce inflammatory  Reduces inflammatory
response response

Antibiotics:
 Kills microorganisms Hormones:
 Reduce inflammatory  Reduce sebum
response production
 Skin care for acne patients
• No need to overdose on cleansing!
• Soap free cleansing/soap substitute washes
• Use non-comedogenic cleansers, make up and
moisturisers (oil free)
• Avoid greasy products
• Educate re squeezing and associated scarring
 When to Refer

Criteria for referral

• Severe nodulo-cystic acne (refer immediately)
• Risk/evidence of scarring and post-
inflammatory hyperpigmentation (PIH)
• Moderate acne that has failed to respond to 2
or more courses of treatments
• Mild to moderate acne in patients who have
extreme psychological distress

Galderma Nurse Team

Acne Academy Website
www.acneacademy.org