ACNE VULGARIS

FA R M A K O T E R A P I I I
 ACNE VULGARIS

• Acne is a self
limiting
disease
involving
inflammation
of the
sebaceous
follicles of the
face and upper
 ACNE VULGARIS

• Four primary factors are identified as being

involved in the four formation of acne lesions:
increased sebum production, sloughing of
keratinocytes, bacterial growth, and
inflammation.
• Acne progresses through four stages: (1)
increased follicular keratinization, (2)increased
sebum production,
(3) Bacterial lipolysis of sebum
triglycerides to free fatty acids,and
(4) inflammation.
 PROGRESS OF ACNE

A B
C D
FORMATION OF ACNE LESSION
 ACNE VULGARIS

• Usually beginning during adolescence, acne

persists for years and cannot be cured, only
controlled.
• Propionibacterium acnes overgrowth also
contributes to inflammation
• Drug therapies work by reducing sebum
production, normalizing keratinization in the
pilosebaceous units, reducing P. acnes, or
reducing inflammation
POTENTIAL CONTRIBUTING FACTOR TO
ACNE VULGARIS
 CLINICAL PRESENTATION

• Lesions usually occur on the face, back,

upper chest, and shoulders.
• LABORATORY TESTS : There are no laboratory
tests to diagnose acne vulgaris. Diagnosis is
based on clinical signs.
• The disease is categorized as : mild,
moderate, or severe, depending on the type
and severity of lesions.
KETERANGAN
 TREATMENT
ACNE VULGARIS
FA R M A KO T E RA P I I I
 GENERAL APPROACH

Nonpharmacology Pharmacology
therapy therapy
 NONPHARMACOLOGY THERAPY

• Encourage patients to avoid aggravating

factors, maintaina balanced diet, and control
stress.
• Patients should washno more than twice
daily with a mild, nonfragranced opaque or
glycerin soap or a soapless cleanser.Scrubbing
should be minimized to prevent follicular
rupture.
• Comedone extraction results in immediate
cosmeticimprovement but has not been
widely tested in clinical trials.
 PHARMACOLOGY THERAPY

• Comedonal noninflammatory acne:

Select topical agents that target
the increased keratinization by producing
exfoliation. Topical retinoids (especially
adapalene) are drugs of choice.
Benzoyl peroxide or azelaic acid can be
considered.
 PHARMACOLOGY THERAPY

• Mild to moderate papulo pustular

inflammatory acne:
the fixed-dose combination of adapalene and
benzoyl peroxide or the fixed-dose
combination of topical clindamycin and
benzoyl peroxide is first choice therapy.
As alternatives, a different topical retinoid
used with a different topical antimicrobial
agent could be used, with or without
benzoyl peroxide. Azelaic acid or benzoyl
peroxide can also be recommended
 PHARMACOLOGY THERAPY

• Severe papulopustular or moderate nodular acne:

Oral isotretinoin monotherapy is first
choice. Alternatives include systemicantibiotics
in combination with adapalene, with the fixed-
dose combination of adapalene and benzoyl
peroxide or in combination with azelaic acid. If
there are limitations to use of these agents,
consider oral antiandrogens in combination with
oral antibiotics or topical treatments, or systemic
antibiotics in combination with benzoyl peroxide.
 PHARMACOLOGY THERAPY

• Nodular or conglobate acne: Monotherapywith

oral isotretinoin is first choice. An
alternative is systemicantibiotics in
combination with azelaic acid. If limitations
exist to these agents, consider oral
antiandrogens in combination with oral
antibiotics, systemicantibiotics in combination
with adapalene, benzoyl peroxide, or the
adapalene-benzoyl peroxide fixed-dose
combination
 PHARMACOLOGY THERAPY

• Maintenance therapy for acne: Topical

retinoids are most commonly recommended
(adapalene,tazarotene, or tretinoin). Topical
azelaic acid is an alternative. Maintenance is
usually begun after a 12-week induction
period and continues for 3 to 4 months.
A longer duration may be necessary to
prevent relapse upon discontinuation. Long-
term therapy with antibiotics is not
recommended to minimize antibiotic
resistance.
 PEELING AGENT

Salicylic
Sulfur
acid

Resorcino
l
TOPICAL ANTIBACTERIAL AGENT

Benzoyl Eritromisi klindamisi

Perokside n n

Azelaic
Dapson
acid
 ORAL ANTIBIOTIC

Eritromisin Ciprofloxacin TMP-SMF

Minosiklin Dosisiklin
 ANTISEBUM AGENT

Oral
Isotertinoin spironolactone
contraceptives

Cyproterenone Oral
acetate corticosteroid
ISOTRETINOIN
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