ACNE & ADNEXAL

DISORDERS

FK-UGM
Yogyakarta

DISORDER OF ADNEXAL
ADOLESCENS SKIN

SEBACEOUS GLANDS
APOCRINE GLANDS
ECCRINE GLANDS

PHYSIOLOGY OF REGULATORY MECHANISM

Acne vulgaris
Is it important or just
Trivial ?
Is it a disease ?

INSURAN

Embarrasing Devastating

MOST FREQUENT QUESTIONS

DIET CHOCOLATE
-SPICY
-FRIED FOODS
-MILK
STRESS
SEXUAL ACTIVITY

What is ACNE

Not an infectious but

Inflammatory skin condition
Common, chronic, recurring disease
Self limited disease
Influences Quality of Life
Constitute a socioeconomic problem

Why it is important serious disease

1. The morbidity - the prevalence 85% 95%
(100% teenager)
adult acne- women > 21th
-the most common
dermatologic
disorder in US, RSS the II
nd
2. The embarrasing disease
3. The cost - skin care
- treatment of complication - scar

Prevalence

( 85 %) mild
( 15 %) need medical treatment

PREVALENCE
THE MOST COMMON VISIT DERMATOLOGIST AGE
15-45
MAN > WOMAN ------- VISIT OF WOMEN 80% >
FREQUENT
> AGE 19 YRS
US DATA PRESCRIPTION ANTIBIOTICS $ 5
MILLION

ISOTRETINOIN $ 1.4 MILLION

PATHOGENESIS:

ANDROGE
N

5ar type 1

MICROCOMEDONE
Linoleic acid
IL-1 alpha
ABNORMAL KERATINIZATION
Acroinfundibulum
INFLAMMATION
RUPTURE FOLLICLE WALL

TNF
-ALPHA
P.ACNE

LIPASE

SEBUM SECRETION

DHT

Gollnick H et al J.Am.Acad.Dermatol 2003:;49(1 Sup

MICROBIOLOGY OF PILOSEBACEOUS UNIT

STAPHYLOCOCCI, MICROCOCCI
GRAM (+), COAGULASE (-)
PITYROSPOSPORUM OVALE,
PITYROSPORUM ORBICULARE.
LIPOFILIC YEAST
PROPIONEBACTERIUM ACNES,
ANEROBIC PLEOMORHIC DIPHTEROID.
MOST PREVALENT ORGANISM IN
FOLLICULAR

SUPERFICIAL AEROBIC
PORTION OF SEBACEOUS
UNIT

INFRAINFUNDIBULUM
ANAEROBIC
CONDITION OF
SEBACEOUS UNIT
INFLAMATORY
REACTION OCCURS IN
ACNE

PATHOGENESIS:

THE DEVELOPMENT
OF ACNE LESSION

MIKROCOMED
O

COMEDO

INFLAMMATION
LESSION

CLINICAL SIGN:

PRIMARY LESSION

COMEDO

1.OPEN

2.CLOSED

ACNE VULGARIS
DEFINITION:
1. CHRONICALLY INFLAMMATION OF
SEBACEOUS FOLLICLE
2. LESSION COMEDONE-PAPULE-PUSTULENODULE-CYST-SCAR (PLEOMORPHIC)
3. PREDILECTION SEBORRHOIC AREA
4. AGE -PUBERTY

DIAGNOSE OF ACNE VULGARIS:

1. PREDILECTION
2. LESSION
3. SEBORRHOE
4. TEENAGE

CLINICAL VARIATION:

NEONATAL ACNE

ADULT ACNE

ACNE IN COLORED SKIN

SUBTYPES OF ACNE:

CYSTIC ACNE

SUBTYPE ACNE :

ACNE FULMINAN

SUBTYPES ACNE:

MECHANICAL ACNE
ACNE COSMETICA POMADE ACNE

ACNE EXCORIEE

DIFFERENTIAL DIAGNOSIS:

ROSACEA

ERYTHEMATOTELANGIETATIC

PAPULOPUSTULAR

DIFFERENTIAL DIAGNOSIS:

PHYMATOUS

OCULAR

DIFFERENTIAL DIAGNOSIS

ACNEIFORM ERUPTION

* CORTICOSTEROID
* INH
* BROMIDE. IODIDE
* PHENYTOIN

DIFFERENTIAL DIAGNOSIS

PERIORAL DERMATITIS

Perioral Dermatitis, Corticoid Damage

DIFFERENTIAL DIAGNOSIS:

GRAM NEGATIVE FOLLICULITIS

TREATMENT:
ANTI -ANDROGEN
ABNORMAL KERATINIZATION

RETINOIC ACID
INFLAMMATION

P.ACNE

ANTI INFLAMMATION

ANTIBIOTIK
SEBUM SECRETION

Actions of Anti-Acne
Therapies
Topical retinoids:
Normalize follicular
hyperproliferation
and cohesiveness
Reduce
inflammatory
response

Antibiotics:
Reduce
microorganisms
Reduce
inflammatory
response

Benzoyl
peroxide:
Reduces

Oral
Isotretinoin:
Reduces sebum
Normalizes
hyperkeratinizatio
n
Inhibits P. acnes
growth (indirect)
Reduces
inflammatory
response

Hormones:
Reduce sebum
production
Reduce
proliferation
of follicular
keratinocytes

CURRENT ACNE
TREATMENT

TOPICAL -RETINOIDS
-ANTIBIOTICS : CLINDAMYCIN, ERYTHROMYCIN,
NADIFLOXACIN, NA
SULFACETAMIDE,
DAPSONE
-BENZOYL PEROXIDE
-AZELAIC ACID
-SALICYLIC ACID, SULFUR
-NICOTINAMIDE, ASCORBIC ACID
SYSTEMIC -ANTIBIOTICS
-HORMONAL
-ISOTRETINOIN
ADJUVANT -CHEMICAL PEELING
-LASER & LIGHT
-CRYO THERAPY
-DIET

Therapies

Actions of Anti-Acne
Therapies
HyperSebum
Inflammati Reduction
keratinizati

production on
Topical therapies

on

in P.acnes

Retinoids

++

Benzyl
peroxide

++

+++

Antibiotics

++

+++

Azelaic acid

+/-

Nicotinamide

+/-

Systemic therapies
Antibiotics

+++

+++

Hormonal
therapy

++

++

Indirect

Indirect

Retinoids

+++

++

++

++

Layton AM. A review on the treatment of acne vulgaris. Int. J. Clin. Pract. 60(1), 6472 (2006).

TREATMENT:

NON INFLAMMATION

TOPICAL
KERATOLYTIC
COMEDOLYTIC
BACTERICIDAL

TREATMENT:
INFLAMMATION
TOPICAL
= ACNE NONINFLAMMATION
BENZOIL PEROKSIDE
ANTIBIOTIC
SYSTEMIC
ANTIBIOTIC
ANTI INFLAMMATION
HORMON

BROMHIDROSIS
APOCRINE
ECCRINE

BROMHIDROSIS
APOCRINE : BROMIDROSIS
OSMIDROSIS
ECCRINE : KERATINOGENIC-BACTERIAL DEGRADATION OF
MACERATED STRATUM CORNEUM-ODOROGENIC FATTY ACID

BROMHIDROSIS
EXCESSIVE ABNORMAL BODY ODOR
FOUL SMELLING SWEAT-MALODOR
ARISE FROM THE APOCRINE GLAND

BROMHIDROSIS

YOUNG ADULTS
BLACK
SUMMER
FAMILY HISTORY
CULTURAL
SUBJECTIVE -RACES

BROMHIDROSIS PATHOGENESIS

Increase number & size apocrine

glands, increase ratio
apocrine/eccrine -----increase
production
Axillary bacteria ------- methyl 2
hexenoic acid
Short chain fatty acids & ammonia.
Trimethylaminuria- FISH ODOR

PREDISPOSING FACTOR

HYPERHYDROSIS
OBESITY
INTERTRIGO
DIABETES MELLITUS
FOODS - GARLIC
- ALCOHOL
HERITABLE AMINOACIDURIA

BROMHIDROSIS TREATMENT

HYGIENE SOAP & WATER

DEODORANT
REDUCING BACTERIA
REDUCING APOCRINE /ECRINE SWEAT
-ANTIPERSPIRANT
-ABSORBENT POWDERS
-SURGERY- CURRETAGE SUBCUTANEOUS
- EXCISION
- SYMPATHECTOMY
-BOTULINUM TOXIN INJECTION
-IONTOPHORESIS

ANTIPERSPIRANT
Aluminum chloride hexahydrate
Aluminum chlorhydrate
Aluminum sesquichlorohydrate
Aluminum chlorohydrex
Aluminum zirconium tetrachlorohydrate
Formaldehyde 10%
Glutaraldehyde 10%
Methenamine 8%
Glycopyrrolate

Metal ions form precipitating complexes with mucopolysaccharides

--damage to luminal epithelial cell
-- obstructive conglomerate
-- completely plugs the acrosyringium..

DEODORANT

Triclosan
Benzalkonium chloride,
Chlorhexidine.
Propylene glycol
Fragrances

Iontophoresis with tap water by producing a physical

blockage of the sweat ducts at the level of the stratum

Botulinum toxin injection

Botulinum toxin, a neurotoxin, acts by
blocking the release of acetylcholine from
the presynaptic terminal of the
neuromuscular junction. It enters the
cytosol and very specifically cleaves
protein components of the
neuroexocytosis apparatus; consequently,
acetylcholine cannot be released. The use
of Botulinum toxin to block sympathetic
innervation of eccrine sweat glands