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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
Factors:
• Retention hyperkeratosis.
• Propionibacterium acnes
within the follicle.
• Inflammation
Etiology, signs and symptoms
• Acne vulgaris commences in the pilosebaceous
units in the dermis. These units consist of hair
follicle and the associated sebaceous glands.
They are connected to the skin by a
duct(infundibulum) through which the hair shaft
passes.
• Non inflamatory acne; ( acne that characterized
by closed and open comedones )
• The cause of acne is an increase in the activity
of the sebaceous glands and the epithelial tissue
lining the infundibulum.
Etiology, signs and symptoms
• The glands produce more sebum causing
increased oiliness of the skin.
• The epithelial cells become more distinct
,durable and stick together to form a coherent
horny layer which blocks the follicular channel.
This impaction plugs distends the follicle to form
a microcomedo
• NB, normally epidermal cells continually
sloughs off and moves to the surface of the
skin with the sebum.
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.
Initial pathogenesis (reason unknown):
follicular hyperkeratinization
proliferation +
decreased desquamation of keratinocytes
hyperkeratotic plug
(microcomedone)
Pathogenesis
Bacteria thrive
Inflammation results
Depending on conditions
• closed comedo
(a whitehead):
Accumulation of sebum
converts a
microcomedo into this.
Closed comedones (whiteheads)
Open comedo (blackhead)
• open comedo
(a blackhead):
when follicular orifice is
opened + distended.
Melanin + packed
keratinocytes + oxidized
lipids dark colour
Open comedo (blackhead)
Whitehead and blackheads
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:
• ACTH • Disulfiram
• Azathioprine • Halogens
• Barbiturates • Iodides
• Isoniazid • Steroids
• Lithium • Cyclosporine
• phenytoin • Vitamins B2,6,12
Treatment of Acne Vulgaris
• ERYTHROMYCIN:
• 2% solution in 2:2:1 mix of ethanol- ethylene glycol
monomethyl ether + propylene glycol.
• NB, erythromycin reduce level of fatty acid of the follicles
to the level reached by the oral tetracyclin Why ?
• It is lipid soluble antibiotics which can penetrate the
sebaceous follicle to suppress c. bacterium acne
• Both oral tetracyclin and local erythromycin are
prescription drugs only.
Effect of sunlight
• Is often beneficial in acne conditions, due to the
irritant properties of the UV rays.
Secondary formulation factors.
. Lotion and creams, are generally used as the
vehicles to carry anti acne medication to the
skin. They should have a low fat content so that
they do not counteract drying and peeling.
.ethyl or isopropyl alcohol added to the liquid
preparations and gels hastens their drying to a
film.
Comedonal acne
• Topical antibiotic
• Combination of both
• Topical antibiotics
• Eliminate P. Acne
• Reduce inflammation
Clindamycin
Erythromycin
Tetracycline
Metronidazole
Azelaic acid
Moderate to severe acne:
• 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
Moderate to severe acne:
oral isotretinoin
• Oral antibiotics
-Tetracycline - erythromycin
- minocycline - TMP-SMX
- doxycycline - clindamycin