acne in adolescents · acne in adolescents. presidential action plan 2018-19 precious teens...
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Acne in Adolescents
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Objectives
• To discuss pathophysiology of acne
• To outline management of adolescent acne
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Epidemiology and Importance
• 90% of adolescents , all races , both sexes• Family history is often positive • Typically presents at 12-14 , peaks at 15-18, and
resolves by age 25• Face, neck and upper trunk • Menstrual acne 7-10 days before onset of periods ;
stops with onset• Acne –low body image-low self esteem – depression-
anxiety – social phobia - significant negative psychological effect -suicide
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Precious Teens Precious LivesPresidential Action Plan 2018-19
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Case Gulnaz , 15-year-old teenager presents with “pimples” on her face for the last 2 years. She has a daily routine of aggressive facial cleansing with a bar soap during her morning shower.
• Past History: No chronic illnesses / hospitalisation
• Allergies: None • Medications: None • Family history: Both parents had acne
as teens • Social history: High school student
Any other history ?
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Precious Teens Precious LivesPresidential Action Plan 2018-19
HEEADSSS
• Home: lives with parents , both parents had
acne as teenagers
• Education: High school student
• Eating: Eats a balanced diet
• Activities: Avoids moving out
with friends
• Drugs: No smoking / alcohol/ drugs
• Sex: Never been sexually active
• Suicide: No history of depression
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Acne Classification
How do we grade acne ?
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Grades of Acne
Grade I: Comedones (open or closed), occasionally pustules or papules (10); no scarring.
Grade II: comedones, Papules, few pustules (10-40); mild scarring.
Grade III: Predominant pustules (40-100), nodules, abscesses; moderate scarring.
Grade IV: Mainly cysts, abscesses, scars; severe scarring.
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Pathogenesis of Acne
Breaks sebum to highly irritating free fatty acids
Inflammation
Inflammatory acne -lipase
Obstructing plug prevents sebum reaching the skin surface
P. acnes colonizes the pilosebaceous duct
Increased level of circulating androgens Stimulation of sebum production
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Anatomy and Physiology of skin Microcomedone
Closed comedone (whitehead) Open comedone (blackhead)
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Acne with Hirsutism and Alopecia
What would you consider as differential diagnosis ?
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Treatment
• Diet
• Skin care
• Topical Therapy
• Systemic Therapy
• Laser and cosmetic therapy
• Counselling
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Skin CareBasic skin care
No vigorous washing, scrubbing or picking
Cleanse with a gentle soap containing salicylic acid, glycolic acid or benzoyl peroxide
Use noncomedogenic moisturiser, if needed
Based on skin type, choose appropriate vehicle for topical treatments Oily (solutions, gels, pledgets , no moisturizers)
Combination (lotions)
Dry (cream, ointment)
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Topical Therapy
• Benzoyl peroxide
• Azaleic acid
• Salicylic acid and alphahydroxy acids
• Retinoids (Adapalene)
• Topical antibiotics : Clindamycin(1-2%) and erythromycin(2-4%)
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Systemic Treatment
Systemic treatments : when topicals as monotherapy are ineffective
First Line:
Doxycycline 50 mg daily /Minocycline 50 mg BD
Second Line :
Erythromycin 250-400 mg once or twice daily
Azithromycin 500 mg
Clarithromycin 250 mg
TMS 80-400 mg once or twice daily
Combined Oral Contraceptives
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Precious Teens Precious LivesPresidential Action Plan 2018-19
Key Messages
• Acne is commonly seen in adolescence
• Acne occurs due to excessive proliferation of follicular keratinocytes because of increased levels of circulating androgen
• Psychological effects of acne should be assessed and managed carefully in each case
• The treatment includes: Topical Therapy , Systemic Therapy , Skin care , Balanced diet
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Precious Teens Precious LivesPresidential Action Plan 2018-19
ContributorsMission Kishore Uday 2018-19
• Dr Preeti M Galagali
• Dr Atul M Kanikar
• Dr Sushma P Desai
• Dr Chitra Dinakar
• Dr Latha R
• Dr Sandip K Trivedi
• Dr Harmesh S Bains
• Dr Somashekar AR
• Dr Sarala Premkumar
• Dr Poongodi Bala