A C N EA C N E

PROF. SYED ATIF HASNAIN PROF. SYED ATIF HASNAIN KAZMIKAZMI

President Pakistan Association of President Pakistan Association of DermatologistsDermatologists

Dean Faculty of Medicine & AlliedDean Faculty of Medicine & AlliedChairman & Head Department of Chairman & Head Department of

DermatologyDermatologyKEMU/ Mayo Hospital, LahoreKEMU/ Mayo Hospital, Lahore

Prof. Syed Ghulam Shabbir Prof. Syed Ghulam Shabbir (Late)(Late)Founder of Dermatology in PakistanFounder of Dermatology in Pakistan

KING EDWARD MEDICAL UNIVERSITY KING EDWARD MEDICAL UNIVERSITY LAHORELAHORE

MAYO HOSPITAL LAHOREMAYO HOSPITAL LAHORE

ACNEACNE

• Chronic inflammatory disease of the Chronic inflammatory disease of the pilosebaceous follicles seen primarily pilosebaceous follicles seen primarily in adolescentsin adolescents

BASIC LESIONS OF ACNEBASIC LESIONS OF ACNE

Non-inflamed lesionsNon-inflamed lesions

• ComedonesComedones

Inflamed lesionsInflamed lesions

• PapulesPapules

• PustulesPustules

• NodulesNodules

LESIONSLESIONS

• Open comedones (black heads)Open comedones (black heads)

• Closed comedones (white heads)Closed comedones (white heads)

• Inflammatory papulesInflammatory papules

• PustulesPustules

• NodulesNodules

• CystsCysts

• ScarScar

EpidemiologyEpidemiology

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

• Both sexes affected, females report Both sexes affected, females report earlierearlier

• 8-10 years8-10 years

Pilosebaceous UnitPilosebaceous UnitMajor FactorsMajor Factors

• Genetic PredispositionGenetic Predisposition

• SeborrhoeaSeborrhoea

• ComedogenesisComedogenesis

• Bacterial colonizationBacterial colonization

• InflammationInflammation

PathPathoogenesisgenesis

PathPathoogenesisgenesis

Aggravating FactorsAggravating Factors

• Drugs: steroids etc.Drugs: steroids etc.

• StressStress

• Occupations: oils, chemicalsOccupations: oils, chemicals

• CosmeticsCosmetics

• Foods ?Foods ?

• Premenstrual flare Premenstrual flare

Clinical FeaturesClinical Features

•Sites:Sites:– FaceFace– BackBack– Anterior trunkAnterior trunk– Upper armsUpper arms

•Pleomorphic lesionsPleomorphic lesions

Moderate

MiId

Severe

GRADINGGRADING

TYPES OF ACNETYPES OF ACNE

ACNE VULGARISACNE VULGARIS

NODULO-CYSTICNODULO-CYSTICACNEACNE

PUSTULAR ACNEPUSTULAR ACNE

PYODERMA PYODERMA FACIALEFACIALE

ACNE CONGLOBATAACNE CONGLOBATA

STEROID ACNESTEROID ACNE

NEONATAL ACNENEONATAL ACNE

ACNE ACNE EXCORIEEEXCORIEE

ACNE AGMINATAACNE AGMINATA

POMADE ACNEPOMADE ACNE

ManagementManagement

• Severity of acneSeverity of acne• Presence or likelihood of scarringPresence or likelihood of scarring• Psychological impact of the diseasePsychological impact of the disease• Experience with anti-acne therapyExperience with anti-acne therapy• PregnancyPregnancy

• Patient educationPatient education

• Removal of aggravating factorsRemoval of aggravating factors

• Pharmaceutical treatmentPharmaceutical treatment

• Adjunct therapiesAdjunct therapies

• Maintenance therapyMaintenance therapy

Management Management ((contd)contd)

Patient EducationPatient Education

Acne isAcne is

• Not infectious/contagiousNot infectious/contagious

• Not caused by poor hygieneNot caused by poor hygiene

• Not to pick/scratch lesionsNot to pick/scratch lesions

• Acne may worsen premenstruallyAcne may worsen premenstrually

• Improvement may take 4-6 weeksImprovement may take 4-6 weeks

• Worsening may occur during early weeksWorsening may occur during early weeks

• Encouragement to continue the Encouragement to continue the therapytherapy

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

Patient Education Patient Education ((contdcontd))

Topical TherapiesTopical Therapies

• Retinoids (Retinoids (IsotrexIsotrex))

• Benzoyl peroxide (Benzoyl peroxide (BrevoxylBrevoxyl))

• Antibiotics (Antibiotics (ClinagelClinagel))

• Azelaic acidAzelaic acid

• Combination Drugs e.g. Combination Drugs e.g. IsotrexinIsotrexin------Isotretinoin & Erythromycin and Isotretinoin & Erythromycin and DuacDuac---Clindamycin & Benzoyl ---Clindamycin & Benzoyl PeroxidePeroxide

Systemic TherapiesSystemic Therapies

• Antibiotics (Antibiotics (MinodermMinoderm))

• RetinoidsRetinoids

• DapsoneDapsone

• SteroidsSteroids

Why to use Isotretinoin?Why to use Isotretinoin?

• Nodulocystic, disfiguring, resistant Nodulocystic, disfiguring, resistant acneacne

• Presence or likelihood of scarringPresence or likelihood of scarring

• Psychological distressPsychological distress

• Prevention of suicidal tendencyPrevention of suicidal tendency

Nodulocystic AcneNodulocystic Acne

Nodulocystic AcneNodulocystic Acne

Acne ConglobataAcne ConglobataSevere Form of Nodulocystic AcneSevere Form of Nodulocystic Acne

Severe Form ofSevere Form ofNodulocystic AcneNodulocystic Acne

Acne Acne ConglobataConglobata

Nodulocystic AcneNodulocystic Acne

Isotretinoin TherapyIsotretinoin Therapy

Before After

Isotretinoin Side EffectsIsotretinoin Side Effects

• Many Many General side effectsGeneral side effects have been reported such have been reported such as; dryness of the skin and mucous membranes, as; dryness of the skin and mucous membranes, photophobia, muscle and joint pain, insomnia, lethargyphotophobia, muscle and joint pain, insomnia, lethargy

• Central Nervous System side effectsCentral Nervous System side effects include include pseudotumor cerebri, visual disturbances, hearing pseudotumor cerebri, visual disturbances, hearing deficiencies, headache, nausea, malaise and deficiencies, headache, nausea, malaise and drowsiness, Amnesia, hallucinationsdrowsiness, Amnesia, hallucinations

• Psychiatric disordersPsychiatric disorders include behavioural disorders, include behavioural disorders, seizures, psychosis, schizophrenia, depression, suicide seizures, psychosis, schizophrenia, depression, suicide ideation, suicide attempt and suicideideation, suicide attempt and suicide

• Isotretinoin is also a Isotretinoin is also a teratogenteratogen

DRY EYEDRY EYE

CHEILITISCHEILITIS

Mucocutaneous side effects are inevitable but easily tolerated. The

lips and nose are always affected by drying

Sunburn after Isotretinoin TherapySunburn after Isotretinoin Therapy

Acute paronychia after Isotretinoin Acute paronychia after Isotretinoin therapytherapy

MOOD CHANGE - DEPRESSION

Adjunct therapiesAdjunct therapies

• Skin careSkin care– Normal washing, twice dailyNormal washing, twice daily– Avoid physical scrubsAvoid physical scrubs– Soaps containing chlorhexidine not Soaps containing chlorhexidine not

beneficialbeneficial• Comedo extractor/electrocauteryComedo extractor/electrocautery• Chemical peelingChemical peeling• Microderm abrasion/Laser ResurfacingMicroderm abrasion/Laser Resurfacing• Fillers Fillers

Course and PrognosisCourse and Prognosis

• Mostly clear by early twentiesMostly clear by early twenties

• Some may continue in third/fourth Some may continue in third/fourth decadedecade

• Residual scarringResidual scarring

MythsMyths

• Acne only appears during teenageAcne only appears during teenage• Marriage will improve acneMarriage will improve acne• Acne should not be treatedAcne should not be treated• Spicy foods, eggs, mangoes cause Spicy foods, eggs, mangoes cause

acneacne• Betnovate/Archi/Stillmans improve Betnovate/Archi/Stillmans improve

acneacne

THANK YOUTHANK YOU