Dr. MARIA DWIKARYA Sp.KK MEDICAL FACULTY of TARUMANEGARA UNIVERSITYIn JAKARTA

ACNE = inflammation of the pilosebaceus unit of certain areaface + trunk + buttocksAge of onset : Puberty 10 -17 yrs 14 -19 yrs Sex : Males more severe than womanGenetics : Caucasian >> Asian& Africans Familial tendency of severe Cystic Acne : XYY syndromeClimates : Winter >> , Onset Menses >>

PATHOGENESISTIME BOMBComedonesSkin CareCosmeticsFood & FatPUBERTYPsycho & PhysicalBurden StressLipase activity hydrolize LipidSebum Fatty acid Foreign-body response Intense inflammation

PERJALANAN JERAWATCOMEDO NODUS ACNE

MILD ACNEMODERATE ACNESEVERE ACNEACNE SEQUELE

ACNE Classification : Plewig & Kligman 1975 : 1. Acne Comedonal : a. < 10 b. 10-24 c. 25-50 d. > 502. Acne Papulopustule: a. < 10 b. 10-20 c. 21-30 d. >303. Acne Conglobate : Nodule and cystic form.

CIPTO MANGUNKUSUMO Hospital (RSCM Sjarif:1982)Mild Acne: < 10 inflam, not inflam lesion at one siteModerate: < 10 inflam lesion more than one site, > 10 inflam lesion at one siteSevere : > 10 inflam lesion more than one site.

ACNEKOMEDONAL COMEDO White headBlack headTidak meradang Usia remaja Akibat Kosmetik

ACNE COMEDONAL PUSTULOSA

EXTRAKSICOMEDO FACIAL Sendok Unna vs SkinScrubber Ultrasonic

DIFFERENSIAL DIAGNOSES: Face : Rosacea, Perioral dermatitis and Gram Neg FolliculitisTrunk : Pityrosporum Folliculitis caused by Malassezia furfur

ACNEPAPULOPUSTULOSA

Radang ++Gatal / Nyeri/ NanahAntibiotika Oral + Topikal

ACNE PREVENTIONReduce Sebum product. low Fat & Calorie dietReduce Psychological stress: Rest & RelaxGood Style Living : No smoking, No Alcohol drinkSkinCare : Facial Skinwash & Face TonerPersonal Hygiene: Cutting nail, wash hands.

Choice for Acne Therapy KERATOLITICS: Sulfur Precipitatum lot/crm 3-8%Resocinol sol 1-3 %Salicylic Acid sol/crm 2-5 %

Benzoil Peroxide gel 2-5-10%RetinoicAcid cream 0,025-0,05%Adapalene gel 0,1 %

Alpha Hydroxy Acid 3-8-12-20 % ANTIBIOTICSMinocyclin 50 -100mg odDoxycyclin 50 -100mg od

Lincomycin 3dd 500mgClindamycin 2dd 300mgTrimetoprim 3dd 100mgErythromycin 3dd500mg

Topical: Mupirocin cream 2 %Neomycin 0,5%, FucidicAcid 2 %

Acne Steroidalefek samping steroid: infeksi sekunder :Staphylococcus follikulitis

Follikulitis menyerupaiAcne PapuloPustulosa

FollikulitisDermatitisInfeksi Bakterial

AKNEFORMIS ERUPSI******Lokasi di punggungInvasi Bakteri atau Jamur= Follikulitis

Acne Scar :ChemopeelingMicrodermabrasiLaser resurfacingFiller Injection

ISOTRETINOIN= Roaccutane0,5 1 mg / kg bodyweightSecond generation of Vitamin A (1st = Retinal )Long acting :Oral caps 3 x /week, tappering2x, 1x /weekTeratogenic Contra Indication for Pregnancy & Married Woman without Contraception

HEPATOTOXIC: SGOT SGPT check upINCREASE LIPID :Cholesterol & Blood TG check upDRY mouth & eyes: hydration no contact lenseGOOD RESULT for severe Acne *****TRETINOIN = RETIN- AKrim Asam vitamin A

ACNE VULGARISJerawat Komedo(closed, open)Jerawat PapulosaJerawat PapuloPustulosaJerawat PapuloNodosaJerawat KonglobataBopeng bekas Jerawat Pengobatan : Cegah sumbatan, Anti Radang &Seborhea, AntibiotikLotion AntiAcne, Facial Treatment, Chemo Peeling

Faktor EKSTRINSIK penyebab jerawat

Udara panas berkeringat, lengketPolusi : udara berdebu/ berasap. Kosmetika sebagai pelindung kulit akan berubah menjadi polusi bila bercampur dengan keringat dan debu.

Malas membersihkan wajah saat sebelum tidur .

Faktor IntrinsikPeningkatan Hormon Seks pubertas.Peningkatan produksi kelenjar lemak Peningkatan koloni Bakteri penghuni pori2 kulit yang akan mengubah lemak cair menjadi padatSumbatan Komedo di muara pori2.

Makanan berlemak & pedas Coklat, gorengan, kari bersantan Cabai merangsang berkeringatSumbatan menyebabkan kantong kelenjar bocor, timbul radang.

Lelah sehingga malas cuci wajahKurang tidur, kecemasan, sedihKEBIASAAN MEMIJAT JERAWATSTRESSFISIKSTRESSPSIKIS

Chronic Inflammatory acneformis Facial pilosebaseous unitIncrease reactivity of cappilariesFlushing & TelangiectasiaStage IErythema TelangiectasiaStage IIErythema Telangiectasia Papul, tiny PustuleStage IIIErythemaDenseTelangictasia Papulo Nodul Edema centralpart

ROSACEA

Berbagai stadiumRosacea I + II + III

Characteristics of RosaceaAge of Onset : 30 50 yrsRace : Phototype I & II >>> Mediteran>>Sex : Female >>, Rhinophyma: Male >>Characteristics : No Comedones Sebaceous Hyperplasia (+)

Demodex folliculorum (++)Dermatopathology: perifolicular & pericapilar inflammation , dilated capillaries,epitheloid granuloma. LUPUS ERITEMATOSUSR O S A C E ADIFF. DIAGNOSIS : Lupus Eritematosus

ROSACEA MANAGEMENT : *************************Reduction of Alcoholic beverages & Spicy foodsTopical Metronidazole gel/cream 1% once daily Sulfur : lotio Kumerfeldi 5 10 % Permethrine cream ( Scabimite )

Systemic Antibiotic: Mino/ Doxycyclin 2 dd 100 mg/day Metronidazole 2 dd 500 mg/dayOral Isotretinoin for stage II and IIILaser Surgery for nose with Rhinophyma.