Acne vulgaris &

Lichen Planus

Bereket Admasu, MD
Dermatovenerologist
Nov/2022

12/17/23
 1) Acne Vulgaris
 Is a chronic inflammatory disorder of
pilosebaceous unit of adolescents and
young adults

 ch-zed by development of comedones,

papules, pustules, nodules, and cysts.
 Etio-pathogenesis

.
 Acne predominantly affects adolescents.

 The peak incidence is between ages 14-16 years

in girls and 16-19years in boys.

 The basic cause is still unknown

 Pathogenesis….

 Multifactorial disease-developing in the sebaceous

follicles:-
 Follicular hyper keratinization
 ↑ Sebum production
 Colonization with propionibacterium
 Inflammation

_ The above are leads to release inflammatory mediators

like ( accumulation of T helper Lymph.
Neutrophils ,foreign giant cells and this turn to produce
different clinical manifestations..
 Clinical Features

 The disease is ch-zed by a great variety of lesions which

vary from patient to patient.

- The lesions are:

. Comedones : black (open)
white (closed)
. Papules
. Pustules
. Nodules
. Cysts (pus filled acne lesions)
. There may be post inflammatory hyperpigmentation.
. Scarring frequently follows severe type of acne.
 C/F Ctd….
 The common sites are :
- The face, the upper chest and the upper arm

 Most acne patients have an oily skin with patulous

follicular openings.

 The course of the disease is chronic with

frequent remission and relapse

 In majority of the cases, disease tends to

subside spontaneously about the age of 25, but
may persist indefinitely
comedones..
 Variants of Acne

 .Infantile acne:
mainly seen in infants and children, ch-zed by presence of comedones, papules or
pustules on the face

 Acne conglobata:
Severe suppurative form of acne .
Ch-zed by presence of comedones, nodules and cysts with burrowing abscesses
and irregular scarring.
The lesions are situated chiefly on the back, chest. shoulders and buttocks

 Acne Fulminans: severe cystic acne with systemic manifestations( fever,

generalized arthritis.
 Diagnosis
Clinical findings:
► Oiliness of the skin of the face
► Presence of:
Comedones
Papules
Pustules
Nodules
Cysts
Abscesses
Scars
. Treatment

 There are several major approaches to Rx of acne

vulgaris including:
1.General Treatment:
-Oiliness of the skin is best controlled by washing the face with soap
water, at least twice a day.
- Avoid greasy cosmetics.
- No dietary restrictions
.-Psychiatry counseling-in severe cases of acne with emotional upset.
- Pts should be advised to avoid further squeezing or manipulation of the
lesions
 Treatment….

2.Drug Treatment:
a. Drugs that normalize pattern of follicular keratinization
Retinoid: Adapalene, tazarotene, isotretinoin, tretinoin
b. Drugs with antibacterial effects:
Antibiotics (Topical and oral)
Benzoyl Peroxide
Isotretinoin ( indirect effect)
c. Drugs with anti-inflammatory effect
. Antibiotics ( prevent neutrophil chemotaxis)
. Corticosteroids ( intralesional)
d. Drugs that inhibit sebaceous gland function:
. Antiandrogens ( e.g. spironolactone)
. Estrogens (Oral Contraceptives)
. Oral Isotretinoin
. Corticosteroids ( Oral in very low doses
 Treatment ctd….

3.Physical modalities:
-Exposure to UV light
-Irradiation and exfoliation with CO2 snow
-Dermabrasion may be required for Rx of depressed scars
-Comedone extraction
 Severity Grading
 Mild acne
o Comedones are the predominant lesions
o Less number of papules and nodules

 Moderate acne
o More papules and pustules on the face
o Comedones
o Lesions could also be present on the trunk

 Severe Acne
o Widespread papulo-pustular lesions
o Nodules, cysts
o Moderate acne fail to set with in 6 month of Rx
o Acne of any severity with significant psychosocial impact
o Nodular acne with systemic symptoms
 DRUG THERAPY
GENERAL RECOMMENDATION;

Patients with Mild acne;

Topical therapy

Patients with Moderate acne;

Oral & Topical Therapies

Patients with Severe acne;

Oral isotretinoin
 2) Lichen Planus
 Is idiopathic, pruritic inflammatory skin disorder.

 Sites commonly affected; flexural surfaces of the upper

extremities, genitalia & mucous membranes.

 Six P's: Purple, Polygonal, Planar, Pruritic, Papule &

Plaques.

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 Clinical Manifestations
 Classic:
– faintly erythematous- violaceous,
flat-topped, polygonal papule

– Thin, transparent & adherent scale

– Fine, whitish puncta or reticulated networks
Wickham striae
Generalized LP ;
• spreads within 1- 4 months.
• Initial lesions: extremities ;
lower > upper

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 C/F ctd….
• SYMPTOMS:- mostly pruritis, but not
always
– Related to the extent of involvement
• hypertrophic:- localized but extremely pruritic
– Oral: asym. unless erosions / ulcers -
extremely painful
• Isomorphic (Koebner) response
• Healing: hyper pigmentation (darker skin)

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 Diagnosis

• Typical papule of Lichen planus :-

sufficient

• Histopathology & Immunoflourescence

evaluation:
– Atypical lesions.

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 Treatment

• Benign disease ; spontaneous remissions & exacerbations.

• Treatment : challenging and discouraging

• Treatment options:
– Topical steroids, local steroid injection
– Systemic steroids

• Avoidance of exacerbating drugs

• Minimizing trauma .

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 Lichen Planus – Treatment options

12/17/23
THANK YOU!!!!