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ACNE

Skin

Acne
Acne is chronic inflammatory disorder of
the pilosebaceous unit in which a
microcomedo develops as the initial
condition.

Etiology

Cosmetic use
Emotional factors
Medication use (Phenytoin, isoniazid,
phenobarbital, lithium, ethionamid,
steroids)
Environmental and Physical factor
Heredity
Hormonal factors

ACNE

Pathogenesis of acne
Sebaceous glands hyper-activity
Pilosebaceous duct obstruction
Bacterial colonization and inflammation

Papula

Pustula

Nodul

The cause of acne (1)


The effect of Androgen hormones
Im Androgen

Increases sebum secretion

Hyperkeratinization

COMEDONES
Whiteheads or closed comedones
stays beneath the skin. Slightly raised, light
coloured lesion
Caused by build up of debris ( cells + sebum)
within follicle

Blackheads or open comedones


a whitehead becomes a blackhead when
it enlarges until a dark plug protrudes through
the skin surface
* Both whiteheads and blackheads may
stay on the skin for a long time.
* Whiteheads and Blackheads are noninflammatory

The cause of acne (2)


The effect of Propionobacterium acnes
We love
sebum

Hydrolyzes sebum

Free fatty acids

Inflammatory acne

THE INFLAMATORY ACNE


PAPULOPUSTULE
NODULE
CYSTE
ACNE CONGLOBATA
ROSACEA
ACNEIFORM ERUPTION

THE CICATRICIAL ACNE

Assesment of acne severity

Mild/comedonal acne : < 10 on face


Papular acne : 10-25 papules
Pustular acne : > 25 pustules

ACNE TREATMENT
Drugs
Dermatological Procedures
Cosmetics
and/or
Squeeze the pimple

Drug therapy
Normalizing follicular keratinization (retinoid,
azelaic acid, benzoil peroxide)
Decreasing sebum production (isotretionin,
hormone)
Supressing bacterial flora (antibiotics,
benzoil peroxide, azelaic acid, isotretionin)
Preventing inflammatory response
(antibiotics, retinoids)

Treatment
Topical agents
Topical agents such as benzoyl peroxide and retinoic
acid (vitamin A, Retin A) are used to dry and to peel
the skin. This effect increases cell turnover and opens
the follicles and facilitates the movement of sebum to the
skin. Benzoyl peroxide also works to eliminate P. acnes.
Retin A may lead to excessive drying and redness of the
skin, and individuals using Retin A must avoid
unprotected sun exposure. Pregnant women are advised
to avoid using Retin A.
Antibacterial soap may reduce bacterial contamination of
the skin.

Topical antibiotics
Topically applied antibiotics, often in combination with benzoyl
peroxide, may be prescribed for use once or twice a day. Topical
antibiotics, usually tetracycline, erythromycin, or clindamycin, work to
reduce P. acnes proliferation. Treatment with this regimen typically
takes at least 4 weeks to induce notable improvement.
Oral antibiotic
Oral low-dose antibiotic therapy (e.g., tetracycline, doxycycline) may
be administered to reduce bacterial proliferation in the follicle.
Antibiotic therapy requires several weeks to be effective and may
induce photosensitivity. Oral tetracycline damages developing teeth;
therefore, it is contraindicated in pregnant women or women planning
to get pregnant. Tetracycline is also a drug of choice for rosacea.
Birth-control pills containing estrogen can reduce sebum production.
They may be used to treat acne in girls and women.
Systemic 13-cis-retinoic acid (isotretinoin)
Systemic 13-cis-retinoic acid (isotretinoin) may be used for severe
nodular cystic acne. This drug can cause severe birth defects and
should not be used by young women who are or may get pregnant.
Males likewise should avoid impregnating a partner while on
isotretinoin.

DERMATOLOGICAL
PROCEDURE
Peeling with drying and keratolytic agents : sulfur,
salicylic acid, resorcinol, benzoyl peroxide

COSMETICS
Traditionally the anti-acne approach has
used drying keratolytic ingredients:
Benzoyl peroxide (5 or 10%)
Salicylic acid (0.5 or 2%)
Sulfur (~2%)

ALGORITMA TERAPI

COMMON COMPLAIN ON ACNE TREATMENT


(1)

IRRITATION

ALMOST LOOK
NOTHING WRONG

ALWAYS COMPLAINING OF ITCHY SENSATION


SOMETIME MILD REDNESS

WORSEN THE LESIONS


(2)

INCREASE NUMBER OF LESIONS AND THE REDNESS

1ST VISIT WHEN SHE


COMPLAINING WORSEN
OF THE LESION

3
2 WEEK AFTER
RETREATMENT

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ACNE