1.

2. A C N E PROF. SYED ATIF HASNAIN KAZMI President Pakistan Association of Dermatologists Dean Faculty of Medicine & Allied Chairman & Head Department of Dermatology KEMU/ Mayo Hospital, Lahore 3. Prof. Syed Ghulam Shabbir(Late) Founder of Dermatology in Pakistan 4. KING EDWARD MEDICAL UNIVERSITY LAHORE 5. MAYO HOSPITAL LAHORE 6. ACNE

Chronic inflammatory disease of the pilosebaceous follicles seen primarily in adolescents

7. BASIC LESIONS OF ACNE

Non-inflamed lesions

Comedones

Inflamed lesions

Papules

Pustules

Nodules

8. LESIONS

Open comedones (black heads)

Closed comedones (white heads)

Inflammatory papules

Pustules

Nodules

Cysts

Scar

9. Epidemiology

80% of adolescents and young adults (11-30 years)

Both sexes affected, females report earlier

8-10 years

10.

Pilosebaceous Unit

Major Factors

Genetic Predisposition

Seborrhoea

Comedogenesis

Bacterial colonization

Inflammation

11. Path o genesis 12. Path o genesis 13. Aggravating Factors

Drugs: steroids etc.

Stress

Occupations: oils, chemicals

Cosmetics

Foods ?

Premenstrual flare

14. Clinical Features

Sites:

• Face

• Back

• Anterior trunk

• Upper arms

Pleomorphic lesions

15. M o derate Mi I d Severe GRADING 16. TYPES OF ACNE 17. ACNE VULGARIS 18. NODULO-CYSTIC ACNE 19. PUSTULAR ACNE 20. PYODERMAFACIALE 21. ACNE CONGLOBATA 22. STEROID ACNE 23. NEONATAL ACNE 24. ACNEEXCORIEE 25. ACNE AGMINATA 26. POMADE ACNE 27. Management

Severity of acne

Presence or likelihood of scarring

Psychological impact of the disease

Experience with anti-acne therapy

Pregnancy

28.

Patient education

Removal of aggravating factors

Pharmaceutical treatment

Adjunct therapies

Maintenance therapy

Management( contd) 29. Patient Education

Acne is

Not infectious/contagious

Not caused by poor hygiene

Not to pick/scratch lesions

Acne may worsen premenstrually

Improvement may take 4-6 weeks

Worsening may occur during early weeks

30.

Encouragement to continue the therapy

Whole face needs to be treated and not the visible spots only

Patient Education( contd ) 31. Topical Therapies

Retinoids ( Isotrex )

Benzoyl peroxide ( Brevoxyl )

Antibiotics ( Clinagel )

Azelaic acid

Combination Drugs e.g.Isotrexin ---Isotretinoin & Erythromycin andDuac ---Clindamycin & Benzoyl Peroxide

32. Systemic Therapies

Antibiotics ( Minoderm )

Retinoids

Dapsone

Steroids

33. 34. 35. 36. Why to use Isotretinoin?

Nodulocystic, disfiguring, resistant acne

Presence or likelihood of scarring

Psychological distress

Prevention of suicidal tendency

37. Nodulocystic Acne 38. Nodulocystic Acne 39. Acne Conglobata Severe Form of Nodulocystic Acne 40. Severe Form of Nodulocystic Acne Acne Conglobata 41. Nodulocystic Acne 42. Isotretinoin Therapy Before After 43. Isotretinoin Side Effects

ManyGeneral side effectshave been reported such as; dryness of the skin and mucous membranes, photophobia, muscle and joint pain, insomnia, lethargy

Central Nervous System side effectsinclude pseudotumor cerebri, visual disturbances, hearing deficiencies, headache, nausea, malaise and drowsiness, Amnesia, hallucinations

Psychiatric disordersinclude behavioural disorders, seizures, psychosis, schizophrenia, depression, suicide ideation, suicide attempt and suicide

Isotretinoin is also ateratogen

44. DRY EYE 45. CHEILITIS 46. Mucocutaneous side effects are inevitable but easily tolerated. The lips and nose are always affected by drying 47. 48. Sunburn after Isotretinoin Therapy 49. Acute paronychia after Isotretinoin therapy 50. MOOD CHANGE - DEPRESSION 51. Adjunct therapies

Skin care

• Normal washing, twice daily

• Avoid physical scrubs

• Soaps containing chlorhexidine not beneficial

Comedo extractor/electrocautery

Chemical peeling

Microderm abrasion/Laser Resurfacing

Fillers

52. Course and Prognosis

Mostly clear by early twenties

Some may continue in third/fourth decade

Residual scarring

53. Myths

Acne only appears during teenage

Marriage will improve acne

Acne should not be treated

Spicy foods, eggs, mangoes cause acne

Betnovate/Archi/Stillmans improve acne

54.

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