ACNE VULGARIS

Dr. Pasid Harlisa, Sp.KK

Bagian Ilmu Kesehatan Kulit dan Kelamin

Fakultas Kedokteran, Universitas Islam Sultan Agung Semarang ~ 2007

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Acne Vulgaris
Definition : disorder of the pilosebaceous unit there is large number of keratin mass that expands to fill the lumen & forms the solid plug in ductus pilosebaceous. Clinical finding : there is comedones, papules, pustules, nodules, cysts
Etiology : Genetic Endocrine Psychis Food/diet Seasons Cosmetical Injury etc.

Acne Vulgaris
Patophysiology : Patiens with acne have

An increased sebum production Abnormal keratinization Microorganisms colonisation Inflammation

PUBERTY

ANDROGEN HORMONE

SEBUM PRODUCTION

KERATIN FORMING

P. ACNES (LIPASE)

SOLID PLUG IN DUCTUS PILOSEBACEOUS FREE FATTY ACID

ANDROGEN HORMONE

Classification

By Kligman & Plewig, 1975

Comedonal acne Papulo-pustules acne Conglobata acne

True Acne:

By Grupper, 1977

Acne Vulgaris :

Tropical acne Mechanic acne Fulminan acne Neonatal acne

True Acne:

Acne Venenata :

Cosmetical acne
Chlor acne Occupational acne Senile acne Radiation acne

Acne Physical :

Acneiform Eruption Acne like

Diagnosis Base

Anamnesis

Medical History

Age, education, occupancy Physically depressed Climate/season Diet/foods Oily skin Comedonal / non comedonal Another lesion

Cosmetical Menstruation Injury Drugs

Physical Examination

Differential Diagnose

Acneiform eruption Rosacea Perioral Dermatitis

Adenoma sebaceous Molluscum contagiosum Verucca plana

Acneiform eruption

Initially by inflammation (papulo pustulosa) Absence of comedones Usually caused by drugs Suddenly onset Affected to wide area Doesnt match to acne location

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Causative drugs

Iodine Bromide INH Corticosteroid

Vitamin B12 Phenobarbital Tetracycline

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Therapy
Goal:

To To To To

decrease cebum production eliminate keratin plug decrease microorganisms populations eliminate inflammation

Methods:

Skin care

Therapy
Special Treatment

TOPICAL & SYSTEMIC COMBINATIO N

12 SKIN CARE CLEANS FACE

Using: Antiseptic bar Tonic/cream cleanser

2 3 TIMES/DAY
Keratolitic Agent: TOPICAL THERAP Y

Removing: Grime/dust dead cell sebum

Vitamin A acid 0.025-0.1 % Benzoyl peroxide 2.5-10 % Azelaic acid 15 %

Sulfur presipitatum 4 10 % Salicyl Acid 2-5 % Resorcinol Alpha Hydroxi acid

Antibiotic: Erythromycin 1-2 % (solution, cream, gel) Clindamycin HCl/Phosphate 1 % (solution, gel) Benzoyl peroxide 2.5 10 % (solution, cream, gel)

13 Antibiotics Anti androgen Estrogen Corticosteroid Tertracycline & its derivate Erythromycin Clindamycin Linchomycin

Systemic Therapy

Hormones

Isotretinoin ( 13 cis retinoic acid )

Combination Therapy

Topical & Systemic

Comedo Extraction Triamcinolone acetonede intra lesion Dermabration

Special Treatment