ACNE

dr. Monica Sylviana

 Acne Vulgaris
Acne vulgaris is a common chronic skin disease involving blockage and/or inflammation of pilosebaceous
units (hair follicles and their accompanying sebaceous gland). Acne can present as noninflammatory lesions,
inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.
 Pathogenesis
Acne develops as a result of an interplay of the following four factors:
(1) follicular epidermal hyperproliferation with subsequent plugging of the follicle
(2) excess sebum production
(3) the presence and activity of the commensal bacteria Propionibacterium acnes
(4) inflammation.
 Sign n Symptoms
Acne vulgaris typically affects the areas of skin with the densest population of sebaceous follicles (eg, face, upper chest, back).

Local symptoms of acne vulgaris may include pain, tenderness, or erythema.

Systemic symptoms are most often absent in acne vulgaris.

This severe form of acne frequently heals with disfiguring scars. Additionally, acne vulgaris may have a psychological impact on
any patient, regardless of the severity or the grade of the disease.
 Type
Comedonal acne : Presence of open and closed comedones but usually no inflammatory papules or nodules

Mild acne : Presence of comedones and a few papulopustules

Moderate acne : Presence of comedones, inflammatory papules, and pustules; a greater number of lesions are present than in
milder inflammatory acne

Nodulocystic acne : Presence of comedones, inflammatory lesions, and large nodules greater than 5 mm in diameter; scarring
is often evident

Acne conglobata : Severe acne, characterized by multiple comedones, interconnecting abcess, without the presence of
systemic symptoms
Comedonal acne
Mild Acne
Moderate Acne
Nodulocystic Acne
Acne conglobata
 Risk Factor
Genetics
Hormonal

Acne can be irritated or made worse by:

Wearing straps or other tight-fitting items that rub against the skin (such as a football
player wearing shoulder pads), as well as using equipment that rubs against the body
(such as a violin held between the cheek and shoulder). Helmets, bra straps,
headbands, and turtleneck sweaters also may cause acne to get worse.
Using skin and hair care products that contain irritating substances.
Washing the face too often or scrubbing the face too hard. Using harsh soaps or very
hot water can also cause acne to get worse.
Experiencing a lot of stress.
Touching the face a lot.
Sweating a lot.
Having hair hanging in the face, which can cause the skin to be oilier.
Taking certain medicines, such as corticosteroids, some barbiturates, or lithium.
Athletes or bodybuilders who take anabolic steroids are also at risk for getting acne.1
 Rosacea
Rosacea is a chronic rash involving the central face that most often affects those aged 30 to 60. It is common in those with fair skin,
blue eyes. It may be transient, recurrent or persistent and is characterised by its colour, red.

Although once known as "acne rosacea", this is incorrect, as it is unrelated to acne.

 Pathogenesis
The skin's innate immune response appears to be important, as high concentrations of antimicrobial peptides such as cathelicidins
have been observed in rosacea. Cathelicidins are part of the skin's normal defence against microbes.

Cathelicidins promote infiltration of neutrophils in the dermis and dilation of blood vessels.Neutrophils release nitric acid also
promoting vasodilation. Fluid leaks out of these dilated blood vessels causing swelling (oedema); and proinflammatory cytokines
leak into the dermis, increasing the inflammation.
 Sign & Symptoms
Frequent blushing or flushing
A red face due to persistent redness and/or prominent blood vessels telangiectasia (the first stage or
erythematotelangiectatic rosacea)
Red papules and pustules on the nose, forehead, cheeks and chin often follow (inflammatory or papulopustular rosacea);
rarely, the trunk and upper limbs may also be affected
Dry and flaky facial skin
Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)
Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams
Red, sore or gritty eyelid margins including papules and styes (posterior blepharitis), and sore or tired eyes (conjunctivitis,
keratitis, episcleritis) ocular rosacea
Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening rhinophyma
Firm swelling of other facial areas including the eyelids blepharophyma
Persistent redness and swelling or solid oedema of the upper face due to lymphatic obstruction Morbihan disease
Mild papules & erythema Moderate papules & early pustules
 Treatment
Where possible, reduce factors causing facial flushing.
Avoid oil-based facial creams. Use water-based make-up.
Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction
and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased
production of nitric oxide).
Protect yourself from the sun. Use light oil-free facial sunscreens.
Keep your face cool to reduce flushing: minimise your exposure to hot or spicy foods, alcohol, hot showers and
baths and warm rooms.
Some people find they can reduce facial redness for short periods by holding an ice block in their mouth, between
the gum and cheek