acne vulgaris

ACNE VULGARIS

Acne Pathogenesis

Pathway of Steroid Metabolism

Clinicopathologic correlation of acne lessions

Closed Comedone• The follicular infundibulum is

distended, filled with keratin and sebum, and the follicular epithelium is attenuated

• The follicular ostium is narrow


Open Comedone• Resembles the closed

comedone with the exception of a patulous follicular ostium


Inflammatory papule• Acute and chronic inflammatory

cells surround and infiltrate the follicle, which shows infundibular hyperkeratosis


Nodule• The follicle is filled with acute inflammatory cells

• With the rupture of the distended follicle, there is a foreign body granulomatous response

A. Lower face: comedones, papules, pustules and scars

A. The cheek: large, open comedones and inflammatory papules and pustules that become confluent

A. Papules and nodules on the forehead and cheeks with little scarring apparent

B. Nodular acne with scars on the cheekC. Large nodules on the cheek and chin with

significant scarring

A. Large, confluent nodules with interconnecting channels, with atrophic and hyperplastic scars

B. Extensive nodules on the chest and arms with severe scarring

C. Nodules, crusted, ulcers, and scars on the shoulder

D. Severe nodular acne of the back with little residual uninvolves skin

GRADE I; multiple open comedones GRADE II; closed comedones

Acne Grading

Akne Komedonal dibagi:

• Tingkat I : < 10 komedo pada 1 sisi• Tingkat II : 10-25 komedo pada 1 sisi• Tingkat III : 25-50 komedo pada 1 sisi• Tingkat IV : >50 komedo pada 1 sisi

GRADE III; papulopustules

Akne Tipe PapulopustularLesi terdiri atas campuran komedo dan

lesi yang beradang, terdiri atas pustula atau papula:

• tingkat I: < 10 lesi beradang pada 1 sisi

• tingkat II: 10-20 lesi beradang pada 1 sisi

• tingkat III: 20-30 lesi beradang pada 1 sisi

• tingkat IV: >30 lesi beradang pada 1 sisi

GRADE IV; multiple open comedones, closed comedones, and papulopustules, plus cysts.

Punched-out and ice pick scars on the

cheek

Extensive atrophic

scarring of the back

Severe hypertrophic

scarring of the back

Acne Vulgaris, Scarring

Differential Diagnosis of Acne

TREATMENT

Refractory to treatment: check complianceMaintenance: topical retinoid + Benzoyl peroxyde

Refractory to treatment: check compliance• Exlude gram-negative folliculitis• Female: exclude polycystic ovary syndrome, adrenal or ovarian

tumors, congental adrenal hyperplasia• Males: exclude congenital adrenal hyperplasiaMaintenance: topical retinoid + Benzoyl peroxyde

TREATMENT

TREATMENT

Refractory to treatment: check compliance

• Exlude gram-negative folliculitis• Female: exclude polycystic ovary

syndrome, adrenal or ovarian tumors, congental adrenal hyperplasia

• Males: exclude congenital adrenal hyperplasia

Maintenance: topical retinoid + Benzoyl peroxyde

Acneiform Eruptions

• Steroid Folliculitis• Drug-Induced Acne• Epidermal Growth Factor Receptor Inhibitor-

Assoiated Eruption• Occupatinal Acne and Chloracne• Gram-Negative Folliculitis• Radiation Acne• Tropical Acne• Acne Aestivalis

Steroid Folliculitis• After administration of systemic

glucocorticoid, a folliculitis may appear• Mainly on the trunk, shoulders, and upper

arms, with lesser involvement of the face• Tx: -stop corticosteroid

-topical retinoids-topical antibiotics sometimes

Drug-Induced Acne

Epidermal Growth Factor Receptor (EGFR) Inhibitor-Assoiated

Eruption• EGFR inhibitor primarily used to treat non-small cell lung cancer, colorectal cancer, and breast cancer.

• Ex: gefitinib, cetuximab, erlotinib

Occupatinal Acne and Chloracne• Coal tar derivatives, insoluble cutting oils, and chlorinated hydrocarbons

• Ocupational acne characterized by papules, pustules, large nodules and true cysts

• The lesions are not restricted to the face and more common on covered areas with intimate contact to clothing saturated with the offending compound

• Chloracne means occupational acne caused from chlorinated hydrocarbons

• Tx: topical or oral retinoids and oral antibiotics

Gram-Negative Folliculitis

• May occur in patient with pre-existing acne treated with long-term oral antibiotics, especially tetracyclines

• May appear concentrated around the nose or as deep-seated nodules

• Tx: - Appropriate antimicrobial agent- Recalcitrant cases, improves with oral isotretinoin for 4-5 months- Some cases, oral cephalosporin may be given for 2 weeks combine with isotretinoin

Radiation Acne

• Ionizing radiation and UV radiation may induce acnefrom eruption

• Excessive exposure to UV radiation may produce a yellow, athropic plaque studded with large, open comedones. Known as Favre-Racouchot syndrome

• The lesions: usually symmetrically distributes on the temporal and periorbital areas.

• tx: oral or topical retinoids as well as extraction

Tropical Acne

• Tropical climates• Occurs mainly on the trunk and buttocks• The lesions: deep, large, inflammatory nodues

with multiple draining areas, resembling acne conglobatas

• Tx: - Systemic antibiotics- Removing the patient to a cooler environment

Acne Aestivalis

• A monomorphous eruption, consist of multiple, uniform, red, papular lesions seen after sun exposure

• Almost all cases have occured in women, 20-30 y.o.

• The lesions are common on the shoulders, arms, neck, and chest

Bambang SuhariyatoLAB/SMF KESEHATAN KULIT DAN KELAMIN

FK UJ/ RSD Dr. SOEBANDI JEMBER

TUMOR / BEDAH KULIT

Ilustrasi Kulit dan Adneksa

Epithelial Precancerous Lesions

Actinic Keratoses

Bowenoid Papulosis

Bowen Disease (squamous cell carcinoma in situ)

Erythroplasia of Queyrat

Leukoplakia

XERODERMA PIGMENTOSUM ?

KEGANASAN KULIT

Squamous Cell Carcinoma

Basal Cell Carcinoma

Keratoacanthoma

Tumor Epitel Jinak, Hamartomas dan

Hyperplasias

Seborrheic Keratosis

Epidermal Nevus

Nevus Sebaceous

Nevus Comedonicus

Cysts Of Epidermal Origin

Trichilemmal Cyst (Pilar Cyst)

Milium

Steatocystoma Multiplex

TUMOR ADNEKSA

Syringoma

Trichoepithelioma

Sebaceous Hyperplasia

TUMOR MELANOSITIK

Congenital Nevomelanocytic Nevus

Spitz Nevus

Lentigo Simplex

Solar Lentigo

Atypical / Displatic Nevi

CUTANEOUS MELANOMA

Superficial Spreading Melanoma

Acral Lentiginous Melanoma

Nodular Melanoma

Lentigo Maligna

TUMOR DERMISdengan

FIBROTIK MALIGNANSI

Dermatofibrosarcoma Protuberans

Atypical Fibroxanthoma

Tumor Dermis Jinak

VASCULAR TUMOR

Hemangiomas

KELAINAN RAMBUT

Gambaran Rambut Siklus Normal

• Classify the hair disorder based on pathogenetic principles and clinical pattern.

• Exclude or confirm the most common hair growth disorders based on pattern and diagnostic tools.

• Dispel misconceptions and educate the patient.• Treat as appropriate for the confirmed or suspected

diagnosis.• Provide emotional support for patients who are

adversely affected by the cosmetic effects.

Excess hair

• Hirsuitisme : hair growth in woman under androgen controls : moustache, beard, chest etc.

• Hypertrichosis : refer to hair density or length for particular age, race and sex. Maybe generalized or localized.

FPHL (Female Patern Hair Loss)

PENGOBATAN

Bedah kulit• Bedah Scalpel• Bedah Listrik• Bedah Krio• Laser

Bedah Scalpel

Bedah Listrik

Bedah Krio

Laser (1)• Light Amplification by Stimulated Emission of

Radiation• Cara kerja : berkembang ke selektif

fototermolisis• Selektif fototermolisis: terapi untuk lesi

vaskular, pigmentasi, tattoo, folikel rambut tanpa menyebabkan kerusakan jaringan non target

• Variabel : lama denyutan, fluence dan panjang gelombang. ( kromofor ).

Absorpsi cahaya oleh kromofor kulit sesuai

dengan panjang gelombang.

Kromofor: • molekul yang menyerap

cahaya dengan panjang gelombang tertentu

• kromofor utama pada kulit: – oksihemoglobin, air, dan

melanin

Laser (2)

• EBM terbaik : kel. pigmentasi congenital, tato, hair removal ,kelainan vaskular (terutama : PWS), tumor jinak kulit, rejuvenating (fractional)

• RESIKO penggunaan laser: eye injury, efek samping (pigmentasi, jaringan parut)

Infantile port-wine stain (A) before and (B) after four treatments with a 595 nm, 1.5-msec pulsed dye laser. (Reprinted with permission Arch Derm 2000; 136:942.)

Segmental ulcerating hemangioma. (A) No response to systemic corticosteroids. (B) A response occurs after treatment with alfa interferon and pulsed dye laser.

Laser Tattoo Removal

Spot Test

Fluence 6,5 J/cm2 Wavelength 1064 nm Spotsize 3 mm Rep Rate 10 Hz

Q-switched Nd:YAG laser

Before After Spot Test

Before After 4th Laser Treatment

Before After 2nd Laser Treatment

" terima kasih "semoga bermanfaat

.. terima kasih..

Terima KasihSemoga Bermanfaat

acne vulgaris

Documents