ACNE VULGARIS

Acne Pathogenesis

Pathway of Steroid Metabolism

Clinicopathologic correlation of acne lessions

Closed Comedone The follicular infundibulum is distended, filled with keratin and sebum, and the follicular epithelium is

Clinicopathologic correlation of acne lessions

Open Comedone Resembles the closed comedone with the exception of a patulous

Clinicopathologic correlation of acne lessions

Inflammatory papule Acute and chronic inflammatory cells surround and infiltrate the follicle, which shows infundibular hyperkeratosis

Clinicopathologic correlation of acne lessions

Nodule The follicle is filled with acute inflammatory cells With the rupture of the distended follicle, there is a foreign body

A.

Lower face: comedones, papules, pustules and scars

A.

The cheek: large, open comedones and inflammatory papules and pustules that become confluent

A.

B. C.

Papules and nodules on the forehead and cheeks with little scarring apparent Nodular acne with scars on the cheek Large nodules on the cheek and chin with significant scarring

A.

B.

Large, confluent nodules with interconnecting channels, with atrophic and hyperplastic scars Extensive nodules on the chest and arms

C.

D.

Nodules, crusted, ulcers, and scars on the shoulder Severe nodular acne of the back with little residual uninvolves skin

Acne Grading

ADE I; multiple open comedones

GRADE II; closed comedones

Akne Komedonal dibagi:

Tingkat I Tingkat II Tingkat III Tingkat IV

: < 10 komedo pada 1 sisi : 10-25 komedo pada 1 sisi : 25-50 komedo pada 1 sisi : >50 komedo pada 1 sisi

Akne Tipe Papulopustular Lesi terdiri atas campuran komedo dan lesi yang beradang, terdiri atas pustula atau papula: tingkat I: < 10 lesi beradang pada 1 sisi tingkat II: 10-20 lesi beradang pada 1 sisi tingkat III: 20-30 lesi beradang pada 1 sisi tingkat IV: >30 lesi beradang pada 1 sisi

GRADE III; papulopustules

GRADE IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.

Acne Vulgaris, Scarring

Punched-out and ice pick scars on the cheek

Extensive atrophic scarring of the back

Severe hypertrophic scarring of the back

Differential Diagnosis of Acne

Differential Diagnosis of Acne

Differential Diagnosis of Acne

TREATMENT

Refractory to treatment: check compliance Maintenance: topical retinoid + Benzoyl peroxyde

TREATMENT

Refractory to treatment: check compliance Exlude gram-negative folliculitis Female: exclude polycystic ovary syndrome, adrenal or ovarian tumors, congental adrenal hyperplasia Males: exclude congenital adrenal hyperplasia Maintenance: topical retinoid + Benzoyl peroxyde

TREATMENT
Refractory to treatment: check compliance Exlude gram-negative folliculitis Female: exclude polycystic ovary syndrome, adrenal or ovarian tumors, congental adrenal hyperplasia Males: exclude congenital adrenal hyperplasia Maintenance: topical retinoid + Benzoyl peroxyde

Acneiform Eruptions

Steroid Folliculitis Drug-Induced Acne Epidermal Growth Factor Receptor InhibitorAssoiated Eruption Occupatinal Acne and Chloracne Gram-Negative Folliculitis Radiation Acne Tropical Acne Acne Aestivalis

Steroid Folliculitis

After administration of systemic glucocorticoid, a folliculitis may appear Mainly on the trunk, shoulders, and upper arms, with lesser involvement of the face Tx: -stop corticosteroid -topical retinoids -topical antibiotics sometimes

Drug-Induced Acne

Epidermal Growth Factor Receptor (EGFR) InhibitorEGFR inhibitor primarily used to treat Assoiated Eruption
non-small cell lung cancer, colorectal cancer, and breast cancer. Ex: gefitinib, cetuximab, erlotinib

Occupatinal Acne and Chloracne

Coal tar derivatives, insoluble cutting oils, and chlorinated hydrocarbons Ocupational acne characterized by papules, pustules, large nodules and true cysts The lesions are not restricted to the face and more common on covered areas with intimate contact to clothing saturated with the offending compound Chloracne means occupational acne caused from chlorinated hydrocarbons Tx: topical or oral retinoids and oral antibiotics

Gram-Negative Folliculitis

May occur in patient with pre-existing acne treated with long-term oral antibiotics, especially tetracyclines May appear concentrated around the nose or as deep-seated nodules Tx: - Appropriate antimicrobial agent - Recalcitrant cases, improves with oral isotretinoin for 4-5 months - Some cases, oral cephalosporin may be given for 2 weeks combine with isotretinoin

Radiation Acne

Ionizing radiation and UV radiation may induce acnefrom eruption Excessive exposure to UV radiation may produce a yellow, athropic plaque studded with large, open comedones. Known as FavreRacouchot syndrome The lesions: usually symmetrically distributes on the temporal and periorbital areas. tx: oral or topical retinoids as well as extraction

Tropical Acne

Tropical climates Occurs mainly on the trunk and buttocks The lesions: deep, large, inflammatory nodues with multiple draining areas, resembling acne conglobatas Tx: - Systemic antibiotics - Removing the patient to a cooler environment

Acne Aestivalis

A monomorphous eruption, consist of multiple, uniform, red, papular lesions seen after sun exposure Almost all cases have occured in women, 2030 y.o. The lesions are common on the shoulders, arms, neck, and chest

TUMOR / BEDAH KULIT

Bambang Suhariyato
LAB/SMF KESEHATAN KULIT DAN KELAMIN FK UJ/ RSD Dr. SOEBANDI JEMBER

Ilustrasi Kulit dan Adneksa

Epithelial Precancerous Lesions

Actinic Keratoses

Actinic Keratoses

Bowenoid Papulosis

Bowenoid Papulosis

Bowen Disease (squamous cell carcinoma in situ)

Bowen Disease (squamous cell carcinoma in situ)

Erythroplasia of Queyrat

Erythroplasia of Queyrat

Leukoplakia

XERODERMA PIGMENTOSUM ?

KEGANASAN KULIT

Squamous Cell Carcinoma

Squamous Cell Carcinoma

Squamous Cell Carcinoma

Basal Cell Carcinoma

Basal Cell Carcinoma

Keratoacanthoma

Keratoacanthoma

Tumor Epitel Jinak, Hamartomas dan Hyperplasias

Seborrheic Keratosis

Seborrheic Keratosis

Epidermal Nevus

Epidermal Nevus

Nevus Sebaceous

Nevus Sebaceous

Nevus Comedonicus

Nevus Comedonicus

Cysts Of Epidermal Origin

Cysts Of Epidermal Origin

Cysts Of Epidermal Origin

Trichilemmal Cyst (Pilar Cyst)

Milium

Steatocystoma Multiplex

TUMOR ADNEKSA

Syringoma

Syringoma

Trichoepithelioma

Sebaceous Hyperplasia

TUMOR MELANOSITIK

Congenital Nevomelanocytic Nevus

Congenital Nevomelanocytic Nevus

Congenital Nevomelanocytic Nevus

Spitz Nevus

Spitz Nevus

Lentigo Simplex

Lentigo Simplex

Solar Lentigo

Solar Lentigo

Atypical / Displatic Nevi

Atypical / Displatic Nevi

CUTANEOUS MELANOMA

Superficial Spreading Melanoma

Superficial Spreading Melanoma

Acral Lentiginous Melanoma

Nodular Melanoma

Lentigo Maligna

TUMOR DERMIS dengan FIBROTIK MALIGNANSI

Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma Protuberans

Atypical Fibroxanthoma

Tumor Dermis Jinak

VASCULAR TUMOR

Hemangiomas

Hemangiomas

KELAINAN RAMBUT

Gambaran Rambut Siklus Normal

Classify the hair disorder based on pathogenetic principles and clinical pattern. Exclude or confirm the most common hair growth disorders based on pattern and diagnostic tools. Dispel misconceptions and educate the patient. Treat as appropriate for the confirmed or suspected diagnosis. Provide emotional support for patients who are adversely affected by the cosmetic effects.

Excess hair

Hirsuitisme : hair growth in woman under androgen controls : moustache, beard, chest etc. Hypertrichosis : refer to hair density or length for particular age, race and sex. Maybe generalized or localized.

FPHL (Female Patern Hair Loss)

FPHL (Female Patern Hair Loss)

PENGOBATAN

Bedah kulit

Bedah Scalpel Bedah Listrik Bedah Krio Laser

Bedah Scalpel

Bedah Listrik

Bedah Krio

Laser (1)

Light Amplification by Stimulated Emission of Radiation Cara kerja : berkembang ke selektif fototermolisis Selektif fototermolisis: terapi untuk lesi vaskular, pigmentasi, tattoo, folikel rambut tanpa menyebabkan kerusakan jaringan non target Variabel : lama denyutan, fluence dan panjang gelombang. ( kromofor ).

Absorpsi cahaya oleh kromofor kulit sesuai dengan panjang gelombang.

Kromofor: molekul yang menyerap cahaya dengan panjang gelombang tertentu kromofor utama pada kulit:

oksihemoglobin, air, dan melanin

Laser (2)

EBM terbaik : kel. pigmentasi congenital, tato, hair removal ,kelainan vaskular (terutama : PWS), tumor jinak kulit, rejuvenating (fractional) RESIKO penggunaan laser: eye injury, efek samping (pigmentasi, jaringan parut)

Infantile port-wine stain (A) before and (B) after four treatments with a 595 nm, 1.5msec pulsed dye laser. (Reprinted with permission Arch Derm 2000; 136:942.)

Segmental ulcerating hemangioma. (A) No response to systemic corticosteroids. (B) A response occurs after treatment with alfa interferon and pulsed dye laser.

Laser Tattoo Removal

Spot Test

Before

After Spot Test

Q-switched Nd:YAG laser

Fluence 6,5 J/cm2 Wavelength 1064 nm Spotsize 3 mm Rep Rate 10 Hz

Before

After 4th Laser Treatment

Before

After 4th Laser Treatment

Before

After 2nd Laser Treatment

Before

After 2nd Laser Treatment

" terima kasih " semoga bermanfaat

.. terima kasih..

Terima Kasih Semoga Bermanfaat