Acne

Acne
By: David M. Bracciano, D.O.

Acne Vulgaris
* Chronic inflammatory disease of the pilosebaceous follicles
* Comedones, papules, pustules, cysts, nodules, and often scars
* Face, neck, upper trunk, and upper arms
* Disease of the adolescent
* 90% of all teenagers
* May also begin in twenties
* Usually involution by 25
* Occurs primarily in oily{seborrheic} areas of the skin
* Face occurs; cheeks> nose>forehead>chin
* Ears; comedones in concha, cysts in lobules
* Retroauricular and nuchal cysts

Comedo
* Commonly known as the blackhead
* Basic lesion of acne
* Produced by hyperkeratosis of the lining of the follicles
* Retention of keratin and sebum
* Plugging produced by the comedo dilates the mouth of the follicle
* Papules are formed by inflammation around the comedones

Severity of Acne
* Typical mild acne; comedones predominate
* More severe cases; pustules and papules predominate, heal with scar if deep
* Acne Conglobata; suppurating cystic lesions predominate, and severe scarring results
Types
* Acne comedo; mild case were eruption is composed almost entirely of comedones on an oily skin
* Papular acne; inflammatory papules, most common in young men with coarse, oily skin
* Atrophic acne; residual atrophic pits and scars
Etiology
* Keratin plug in lower infindibulum of hair follicle
* Androgenic stimulation of sebaceous, proliferation of propionbacterium acnes which metabolizes sebum to produce free fatty acids
Pathogenesis
* Disruption of the follicular epithelium permits discharge of the follicular contents into the dermis
* Causes the formation of inflammatory papules, pustules, and nodulocystic lesions
* FFA are chemotactic to components of inflammation
* Effects of tetracycline are obtained by the reduction of FFA
* Antibiotics do not produce involution of the inflammatory lesions present, but inhibit the formation of new lesions
* Topical retinoic acid acts on keratinization, causing horny cells to lose their stickiness
* Androgens enlarge the sebaceous glands
* In women consider hyperandrogenic state

Histology
Treatment
Antibacterials
Tetracyclines
Minocycline
Bacterial Resistance
Oral Contraceptives
Hormonal Therapy
Isotretinoin
Topical Treatment
Benzoyl Peroxide
Topical Retinoids
Topical Antibacterials
Other Topicals
Surgcial Treatment
Intralesional Corticosteroids
Complications of Acne
Acne Conglobata
Acne Fulminans
SAPHO Syndrome
Tropical Acne
Premenstrual Acne
Preadolescent Acne
Neonatal Acne
Infantile Acne
Acne Venenata
Acne Cosmetica
Acne Detergicans
Acne Aestivalis
Excoriated Acne
Acneiform Eruptions
Gram Negative Folliculitis
Acne Keloidalis
Hiradenitis Suppurativa
Perifolliculitis Capitis Abscedens
Acne vs. Rosacea
Ocular Rosacea
Granulomatous Rosacea
Rosacea Etiology
Differential Diagnosis Rosacea
Inflammatory rosacea
Rosacea Treatment
Rosacea Rhinophyma
Pyoderma Faciale
Perioral Dermatitis

Acne.ppt