KULIAH REGULER

2017
 Acne Vulgaris

Definition : disorder of the pilosebaceous

unit there is a 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
Seasonal
Cosmetics
Injury
etc.
Acne Vulgaris
Patophysiology :
Patients with acne have
# An increased sebum production
# Abnormal keratinization
# Microoragisms colonization
# Inflammation
Puberty Androgen hormone k

Sebum Keratin
Productions k Forming k

P. Acnes >>
(Lipase) Solid Plug in
Ductus
Free Fatty Pilosebaceous
Acid
Sebaceous Gland

Androgen
Hormon
 Classification
By Kligman & Plewig, 1975
- Comedonal acne
- Papulo-pustules acne
- Conglobata acne

By Gruper, 1977
- True Acne :
w Acne Vulgaris :
w Tropical acne
w Mechanical acne
w Fulminan acne
w Neonatal acne
Acne Vulgaris
- True Acne :
w Acne Venenata :
w Cosmetical acne
w Chlor acne
w Occupational acne
w Acne Physical :
w Senile acne
w Radiation acne

- Acneiform Eruption Acne like

AV Closed Comedones

AV Opened Comedones
Papulo-pustulous Acnes

Conglobata Acnes
 Neonatal/ Infantil Acnes

Acne Excoriee
 Occupational Acne

Cosmetic Acne
 Diagnosis Base
Anamnesis
Medical History
w Age, education, occupancy
w Cosmetical
w Phsycically depressed
w Menstruations
w Climate / season
w Injury
w Diet / foods
w Drugs
 Physical Examination
w Oily skin
w Comedonal &
non comedonal
w Another lesions
 DifferentialDiagnoses
w Acneiform eruption
w Sebaceaous adenoma
w Rosacea
w Molluscum contagiosum
w Perioral dermatitis
w Verucca plana
Acneiform Eruption
- Initially by inflamation
(papulo pustulosa)
- Absence of comedones

- Usually caused by drugs

- Suddenly onset

- Affected to wide area

- Doesnt match to acne

location
Acneiform Eruption
Causative drugs :
w Iodine w Vitamin B12
w Bromide w Phenobarbital
w INH w Tetracycline
w Corticosteroids
Acneiform Eruption Drug induced acne
Acne Rosacea

A chronic skin disease

3-4th decade of life
Etiology is unknown
Characterized:
- flushing
- teleangiectasia
- follicular papules
- pustules
Factors stimulate:

Hot beverages
Alcohol
Ultraviolet light exposure
Emotional factors
Rosacea Acne Rhynophyma
 Perioral dermatitis

Acneiform skin
eruption
Women aged 20-40
Etiology unknown,
used mid or high
potency topical
steroids
 Therapy
Goals :
To decrease sebum production

To eliminate keratin plug

To decrease microorganisms populations

To eliminate inflammation

Methods :
Skin care
Topical & systemic
Therapy
combination
 Skin Care

Using : Removing :

- Antiseptic bar Cleans Face - Grime/dust

- Tonic/cream cleanser - Dead cell

- sebum

2-3 times/day

Sulfur presipitatum 4- Vitamin A Acid 0.025-

10% Keratolytic 0.1%
Salicyl acid 2-5% Agents : Benzoyl peroxide 2.5-
Resorcinol 10%
Alpha Hydroxic Acid Topical Azelaic Acid 15%
Therapy
Antibiotics :
Erythromycin 1-2% (solution, cream, gel)
Clindamycin HCl/Phosphate 1% (solution, gel)
Benzoyl peroxide 2.5 10% (solution, cream, gel)
 Tetracyline &
Antibiotics its derivates
Systemic
Erythromycin
Therapy
Clindamycin
Anti androgen
Linchomycin
Esterogen
Corticosteroid

Isotretinoin ( 13- cis retinoic acid)

Combination Therapy Topical & Systemic

Comedo Extraction
Tramnicolone acetonide intra
Special Treatments lesion
Dermabaration