Dr. MARIA DWIKARYA Sp.

KK
 ACNE = inflammation of the
pilosebaceus unit of certain area
face + neck + trunk + upper arms + buttocks

Age of onset : Puberty 12 -17 yrs

14 -19 yrs
Sex : Males more severe than woman
Genetics : Caucasian >> Asian & Africans
Familial tendency of severe Cystic Acne
XYY syndrome
Climates : Winter >> , Onset Menses >>
TIME ONSET of ACNE
8-12 yr : PrePubertal Acne comedones
12-17yr : Rising Hormone, Acne PustuleNodules
20-35yr : Persistent ( 3-12 %), PapuloPustules
Area : Chin, Mandible, Upper Neck

85 % of Cases are Adolescence 15-18 yr

Neonatal Acne : few days PP few weeks vanished.
 PATHOGENESIS

Skin Care PUBERTY

Follicular Androgen
Cosmetics Keratinization Sebaceus Psycho & Physical
Food & Fat Plug Activity Burden Stress
TIME BOMB
Comedones

Overgrowth
Bacterial
P. Acnes

Lipase activity hydrolize LipidSebum Disruption follikel

Foreign-body response Intense inflammation
ACNE COMEDONAL PUSTULOSA
 MILD ACNE BIG ACNE SEQUELE
PORES

COME
SCAR
DONE

ACNE
lesion
PAPUL
SINUSES
PUSTUL
NODUL
CYSTIC
MODERATE ACNE SEVERE ACNE
PERJALANAN JERAWAT
COMEDO NODUS ACNE
Aggravating Factors :
Seborrhoe & Stress

Cosmetics & Hygiene Friction & Trauma

LocalPressure Hair removal

HyperAndrogenism
 EVOLUTION
of
ACNE LESIONS

Comedo (black head)

Acne comedo (white head)

Acne papulopustul
Acne icepick scar

Acne konglobata
ACNE Classification :
Plewig & Kligman 1975 :
1. Acne Comedonal : a. < 10 b. 10-24 c. 25-50 d. >
50
2. Acne Papulopustule: a. < 10 b. 10-20 c. 21-30 d.
>30
3. Acne Conglobate : Nodule and cystic form.

CIPTO MANGUNKUSUMO Hospital

(RSCM Sjarif:1982)
Mild Acne: < 10 inflam, not inflam lesion at one
site
Moderate: < 10 inflam lesion more than one site,
> 10 inflam lesion at one site
Severe : > 10 inflam lesion more than one site.
 ACNE
KOMEDONAL

COMEDO
White head
Black head
Tidak meradang
Usia remaja
Akibat Kosmetik
EXTRAKSI
COMEDO FACIAL
Sendok Unna vs
SkinScrubber Ultrasonic
 SPECIAL FORM
ACNE
Acne Acne Acne
COMEDONAL PAPULOPUSTUL NODULOCYSTIC

Acne Mechanica
Acne Aestivalis Acne Fulminant
Acne Cosmetica Acne Excoriae Acne Conglobata
Pomade Acne Acne Steroidal Acne Tropicalis
Chlor Acne Recalcitrant Acne
Drug induced

DIFFERENSIAL DIAGNOSES:
Face : Rosacea, Perioral dermatitis and Gram Neg Folliculitis
Trunk : Pityrosporum Folliculitis caused by Malassezia furfur
 ACNE
PAPULOPUSTULOSA
Radang ++
Gatal / Nyeri/ Nanah
Antibiotika Oral + Topikal
Bedak kocok
AKNE KONGLOBATA
 ACNE PREVENTION
Reduce Sebum product.
Low Fat & Calorie diet
Reduce Psychological No
stress: Rest & Relax
Good Style Living : No
smoking, No Alcohol drink

SkinCare :
Facial Skinwash & Toner
Personal Hygiene:
Cutting nail, wash hands.
 ACNE T H E R A P Y

COMEDONAL PAPULOPUSTUL CONGLOBATA

ANTIBIOTICS O/T
ANTIBIOTICS
KERATOLITICS +
Oral
+ Triamcinolone
Topical
Topical Intra Lesion
+
Tretinoin + drainage
Hormon
Adapalene +
AntiAndrogen ()
Isotretinoin/DDS
 KERATOLITICS:
Sulfur Precipitatum lot/crm 3-8%
Resocinol sol 1-3 %
Salicylic Acid sol/crm 2-5 %
Benzoil Peroxide gel 2-5-10%
RetinoicAcid cream 0,025-0,05%
Adapalene gel 0,1 %
Alpha Hydroxy Acid 3-8-12-20 %
Choice for Acne Therapy
ANTIBIOTICS
Minocyclin 50 -100mg od
Doxycyclin 50 -100mg od
Lincomycin 3dd 500mg
Clindamycin 2dd 300mg
Trimetoprim 3dd 100mg
Erythromycin 3dd500mg
Topical: Mupirocin cream 2 %
Neomycin 0,5%, FucidicAcid 2 %
Acne Steroidal
efek samping steroid:
infeksi sekunder :
Staphylococcus follikulitis
Follikulitis
menyerupai
Acne PapuloPustulosa

AFTER 1 WEEK

THERAPY
NaCl wet cool dressing
Antibiotics and NSAID oral
Antibiotics cream .

BEFORE
 Follikulitis
Dermatitis
Infeksi Bakterial

AFTER 1 WEEK

THERAPY
AntiBiotic and Steroid Oral
Topikal NaCl 0,9 % wet cool dressing
Antibiotic cream only, No using Soap

BEFORE
ACNEFORMIS ERUPTION
****** BEFORE
Follikulitis
Bacterial or Pityrosporum
Therapy
Doxyxiclin 100mg/d X
Ketokonazole 200 mg/d X
Lotio Kumerfeldi 1x/night
Followed by
Tretinoin 0,05 % cream 3 wks

AFTER 1 MONTH
 ICE PICK
SCAR

HyperTROPHIC CANYON type

Scar Chin Atrophic Scar

ACNE
SCAR
Whitish Yellow
ANETODERMA
Papules
Type Trunk
Chin & Trunk
KELOIDAL
Neck & Chest
Contoh Sabun Wajah
AcneVulgaris
Contoh Krim Antibiotika
Paket Perawatan Acne
Vulgaris
Vitamin A Isotretinoin Retinoic
Acid
ISOTRETINOIN= Roaccutane TRETINOIN = RETIN- A
0,5 1 mg / kg bodyweight
Krim Asam vitamin A

Second generation of Vitamin A (1st = Retinal )

Long acting :Oral caps 3 x /week, tappering2x, 1x
/week
Teratogenic Contra Indication for Pregnancy &
Married Woman without
Contraception

HEPATOTOXIC: SGOT SGPT check up

INCREASE LIPID :Cholesterol & Blood TG check
up
DRY mouth & eyes: hydration no contact
lense
GOOD RESULT for severe Acne + AntiBiotic
Acne Scar :
Chemopeeling
Microdermabrasi
Laser resurfacing
Filler Injection
 Chronic Inflammatory acneformis
Facial pilosebaseous unit
Increase reactivity of cappilaries
Flushing & Telangiectasia

Stage II Stage III

Stage I Erythema Erythema
Erythema Telangiectasia DenseTelangictasia
Telangiectasia Papulo Nodul
Papul, tiny Pustule
Edema centralpart
 SEVERE ROSACEA

ROSACEA

Berbagai stadium
Rosacea
I + II + III

MILD ROSACEA MODERATE ROSACEA

 Rosacea
Age of Onset : 30 50 yrs
Race : Phototype I & II >>>
Mediteran>> ROSACEA
Sex : Female >>,
Rhinophyma: Male >>
Characteristics :
No Comedones
Sebaceous Hyperplasia (+)

Demodex folliculorum (++)

Dermatopathology:
perifolicular inflammation
dilated capillaries LUPUS ERITEMATOSUS
epitheloid granuloma.

DIFF. DIAGNOSIS : Lupus Eritematosus

 ROSACEA MANAGEMENT :
*************************
Reduction of Alcoholic beverages & Spicy foods
Topical Metronidazole gel/cream 1% once daily
Sulfur : lotio Kumerfeldi 5 10 %
Permethrine cream ( Scabimite )

Systemic Antibiotic: Mino/ Doxycyclin 2 dd 100 mg/day

Metronidazole 2 dd 500 mg/day
Oral Isotretinoin for stage II and III
Laser Surgery for nose with Rhinophyma.