Prof .Atif Kazmi

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    07-May-2015
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Transcript of Prof .Atif Kazmi

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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.

  • THANK YOU