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ACNE VULGARIS

Wasis Mukti Wibowo 110 208 0106


Andi Rizki Tenryayu 110 211 0150
Supervisor:
Dr. Dian Amelia Abdi, M.Kes,
Sp,KK

Introduction
Acne vulgaris is a chronic inflammation of the pilosebaceous unit
characterized by comedones, papules, pustules, and cysts in the
predilection areas such as the face, shoulders, upper part of the
superior extremities, chest, and back.

Prevalence
Frequency
85-100% of people at some time during their lives.
Sex
males > females during adolescence.
women > men during adulthood.
Age
Adolescent acne usually begins prior to the onset of puberty, when
the adrenal gland begins to produce and release more androgen
hormone.
10-17y.o. female
14-19y.o. male
Acne is not limited to adolescence. 12% of women and 5% of
men at age 25 years have acne.
By age 45 years, 5% of both men and women.

Pathogenesis
1.

Retention hyperkeratosis.

2.

Increased sebum production.

3.

The presence and activity of


Propionibacterium acnes,

4.

Inflammation

Presentation
The primary lesions are comedomes.
They present at the time of puberty
They may extend beyond the face to the shoulders, back and chest
(seborrhaeic areas).
They tend to run a variable course with marked fluctuations, often
being worse in girls who are pre-menstrual.
The severity of the condition varies enormously between individuals.
It is unsightly but the degree of psychological distress does tend to
be disproportionate.

TYPES OF ACNE LESIONS


Noninflammatory/pri
mary lesions:

Inflammatory
lesions

Open
comedones
(blackheads)

Papules (small
red bumps)

Closed
comedones
(whiteheads)

Pustules
(white or
yellow
squeezable
spots)
Inflamed
nodules (large
red lumps)

TYPES OF ACNE LESIONS


Non-inflammatory

Inflammatory lesions

SECONDARY LESIONS
Excoriations (picked or scratched spots)
Erythematous macules (red marks from recently healed spots,
mostly in fair skin)
Pigmented macules (dark marks from old spots, mostly in dark
skin)
Scars

GOALS OF TREATMENT
Normalising shedding into the pore to prevent
blockage
Killing P. acnes
Anti-inflammatory effects
Hormonal manipulation

CLASSIFICATION OF
ACNE
In 1956, Pillsbury, Shelley and Kligman published the earliest
known grading system. The grading includes the following:
Grade 1
Comedones and occasional small cysts confined to the face.
Grade 2
Comedones with occasional pustules and small cysts confined
to the face.
Grade 3
Many comedones and small and large inflammatory papules
and pustules, more extensive but confined to the face.
Grade 4
Many comedones and deep lesions tending to coalesce and
canalize, and involving the face and the upper aspects of the
trunk.

ACNE CLASSIFICATION
Grad
e

Description

Clear skin with no inflammatory or noninflammatory


lesions

Almost clear; rare noninflammatory lesions with no


more than one small inflammatory lesion

Mild severity; greater than Grade 1; some


noninflammatory lesions with no more than a few
inflammatory lesions (papules/pustules only, no nodular
lesions)

Moderate severity; greater than Grade 2; up to many


noninflammatory lesions and may have some
inflammatory lesions, but no more than one small
nodular lesion

Severe; greater than Grade 3; up to many

U.S. Department of Health and Human Services, Food and Drug Administration,

CLASSIFICATION OF ACNE FOR PURPOSE OF


TREATMENT
1. Mild
. Some non-inflammatory lesions on 1 predilection
. Few non-inflammatory lesions in some place predilection
. Slightly inflammatory lesions on 1 predilection
2. Moderate
. Many non-inflammatory lesions at 1 predilection
. Some non-inflammatory lesions at more than 1
predilection
. Some inflammatory lesions at 1 predilection
. Slight inflammatory lesions in more than one predilection
3. Severe
. Many non-inflammatory lesions at more than 1
predilection
. Many inflammatory lesions on one or more of predilection

DIFFERENTIAL
DIAGNOSIS

ACNE ROSACEA
OLDER AGE
FEMALES > MALES
CENTRAL FACE
ERYTHEMA WITH
PROMINENT
TELENGIECTASIAS,
PAPULES,
PUSTULES, EDEMA.
NO COMEDONES,
CYST OR SCARRING

PERIORAL DERMATITIS
PAPULES AND
PAPULOPUSTULE
S
FROM
PROLONGED
THERAPHY OF
STEROIDS.
FLOURINATED
PRODUCTS

GRAM NEGATIVE
FOLLICULITIS
MAY COMPLICATE LONG
TERM ACNE TREATMENTS.
SUDDEN ERUPTIONS OF
SMALL FOLLICULAR
PUSTULES OR AS
DEVELOPMENT OF
NODULOCYSTIC LESIONS.
TX: AMOXICILLIN AND COTRIMOXAZOLE

PITYSPORUM
FOLLICULITIS
Pitysporum yeast.
Erythematous
monomorphic follicular
pustules and papules
Sites of predilection:
trunks and shoulders.
Usually pruritic.
TX: Ketoconazole
200mg x 10 days.
anti fungal creams and
wash.

TREATMENT

TREATMENT
TOPICAL
1. Irritans that can peel
the skins
2. Topical antibiotic
.Oxytetracycline
.Eritromycin
.Clindamycin
topical
1. Topical Antiinflamation
2. Etc -> Etil lactat
10%

SYSTEMIC
1. Systemic anti
bacterial
2. Hormonal
teraphy
3. Isotretinoin
4. Systemic
Corticosteroid

Treatment

Comedonal

Inflammator
y

Nodulocysti
c

Topical therapy

Salicylic acid (Keralyt)

Tretinoin (Retin-A)

Azelaic acid (Azelex)

Benzoyl peroxide

Adapalene (Differin)

Tazarotene (Tazorac)

Antibiotics

X*

Systemic therapy

Oral contraceptives

Erythromycin

Tetracycline

Doxycycline (Vibramycin)

Minocycline (Minocin)

Isotretinoin (Accutane)

Adverse reaction

Tetracyclin
e

Dyspepsia

Doxycycline
(Vibramycin)

Minocyclin
e

Erythromyci
n

Vaginal yeast infection

Photosensitivity

X*

Possible interference with oral


contraceptives

Tooth discoloration in children younger than


13 years or in developing fetuses

Propionibacterium acnes antibiotic


resistance

Hyperpigmentation in scars

Pseudotumor cerebri

Vestibular toxicity

Lupus-like reaction2

Single-organ dysfunction2

Hypersensitivity reaction2

Serum sicknesslike reaction||2

Other treatment options:

Phototheraphy- blue and red light.


Laser treatment
Acne surgery
Cortisone treatment: IL injections.
Peeling

Side Effects of acne

Emotional Distress : Inferiority Complex

Pigmentations

Acne scars :
Ice pick scars - Deep pits, that are the most common and a classic sign of
acne scarring.
Box car scars - Angular scars that usually occur on the temple and cheeks,
and can be either superficial or deep, these are similar to
chickenpox scars.
Rolling scars - Scars that give the skin a wave-like appearance.
Hypertrophic scars - Thickened, or keloid scars.

Acne Scars

Icepick Scars

Boxcar Scars

Rolling Scars

Hypertrophic
Scars

PROGNOSIS
Overall, the prognosis for acne is favorable.

SOURCE
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