ACNE VULGARIS

ACNE VULGARISWasis Mukti Wibowo 110 208 0106Andi Rizki Tenryayu 110 211 0150

Supervisor:Dr. Dian Amelia Abdi, M.Kes, Sp,KKIntroductionAcne vulgaris is a chronic inflammation of the pilosebaceous unit characterized by comedones, papules, pustules, and cysts in the predilection areas such as the face, shoulders, upper part of the superior extremities, chest, and back.PrevalenceFrequency85-100% of people at some time during their lives.

Sexmales > females during adolescence. women > men during adulthood.

AgeAdolescent acne usually begins prior to the onset of puberty, when the adrenal gland begins to produce and release more androgen hormone. 10-17y.o. female14-19y.o. maleAcne is not limited to adolescence. 12% of women and 5% of men at age 25 years have acne. By age 45 years, 5% of both men and women.

PathogenesisRetention hyperkeratosis.Increased sebum production.The presence and activity of Propionibacterium acnes, Inflammation

PresentationThe primary lesions are comedomes. They present at the time of pubertyThey may extend beyond the face to the shoulders, back and chest (seborrhaeic areas).They tend to run a variable course with marked fluctuations, often being worse in girls who are pre-menstrual.The severity of the condition varies enormously between individuals. It is unsightly but the degree of psychological distress does tend to be disproportionate.TYPES OF ACNE LESIONSTYPES OF ACNE LESIONS Non-inflammatory

Inflammatory lesions

SECONDARY LESIONSExcoriations (picked or scratched spots) Erythematous macules (red marks from recently healed spots, mostly in fair skin) Pigmented macules (dark marks from old spots, mostly in dark skin) Scars

GOALS OF TREATMENTNormalising shedding into the pore to prevent blockage Killing P. acnes Anti-inflammatory effects Hormonal manipulation

CLASSIFICATION OF ACNEIn 1956, Pillsbury, Shelley and Kligman published the earliest known grading system. The grading includes the following:Grade 1 Comedones and occasional small cysts confined to the face.Grade 2 Comedones with occasional pustules and small cysts confined to the face.Grade 3Many comedones and small and large inflammatory papules and pustules, more extensive but confined to the face.Grade 4 Many comedones and deep lesions tending to coalesce and canalize, and involving the face and the upper aspects of the trunk.ACNE CLASSIFICATIONGradeDescription0Clear skin with no inflammatory or noninflammatory lesions 1Almost clear; rare noninflammatory lesions with no more than one small inflammatory lesion

2Mild severity; greater than Grade 1; some noninflammatory lesions with no more than a few inflammatory lesions (papules/pustules only, no nodular lesions)

3Moderate severity; greater than Grade 2; up to many noninflammatory lesions and may have some inflammatory lesions, but no more than one small nodular lesion4Severe; greater than Grade 3; up to many noninflammatory lesions and may have some inflammatory lesions, but no more than a few nodular lesionsU.S. Department of Health and Human Services, Food and Drug Administration, CLASSIFICATION OF ACNE FOR PURPOSE OF TREATMENTMildSome non-inflammatory lesions on 1 predilection Few non-inflammatory lesions in some place predilectionSlightly inflammatory lesions on 1 predilectionModerateMany non-inflammatory lesions at 1 predilection Some non-inflammatory lesions at more than 1 predilectionSome inflammatory lesions at 1 predilection Slight inflammatory lesions in more than one predilectionSevereMany non-inflammatory lesions at more than 1 predilection Many inflammatory lesions on one or more of predilection

DIFFERENTIAL DIAGNOSISACNE ROSACEAOLDER AGE FEMALES > MALESCENTRAL FACEERYTHEMA WITH PROMINENT TELENGIECTASIAS, PAPULES, PUSTULES, EDEMA.NO COMEDONES, CYST OR SCARRING

PERIORAL DERMATITISPAPULES AND PAPULOPUSTULESFROM PROLONGED THERAPHY OF STEROIDS.FLOURINATED PRODUCTS

GRAM NEGATIVE FOLLICULITISMAY COMPLICATE LONG TERM ACNE TREATMENTS.SUDDEN ERUPTIONS OF SMALL FOLLICULAR PUSTULES OR AS DEVELOPMENT OF NODULOCYSTIC LESIONS.TX: AMOXICILLIN AND CO-TRIMOXAZOLE

PITYSPORUM FOLLICULITISPitysporum yeast.Erythematous monomorphic follicular pustules and papulesSites of predilection: trunks and shoulders.Usually pruritic.TX: Ketoconazole 200mg x 10 days.anti fungal creams and wash.

TREATMENT

TREATMENTTOPICALIrritans that can peel the skinsTopical antibioticOxytetracyclineEritromycinClindamycin topicalTopical Anti-inflamationEtc -> Etil lactat 10%SYSTEMICSystemic anti bacterialHormonal teraphyIsotretinoinSystemic CorticosteroidTreatmentComedonalInflammatoryNodulocysticTopical therapySalicylic acid (Keralyt)XTretinoin (Retin-A) X X Azelaic acid (Azelex) X X Benzoyl peroxide X X Adapalene (Differin) X X Tazarotene (Tazorac) X X Antibiotics X* X Systemic therapyOral contraceptives X X X Erythromycin X X Tetracycline X X Doxycycline (Vibramycin) X X Minocycline (Minocin)XIsotretinoin (Accutane)X

Adverse reaction Tetracycline Doxycycline (Vibramycin) MinocyclineErythromycinDyspepsiaXXXXVaginal yeast infectionXXXXPhotosensitivityXXX*XPossible interference with oral contraceptivesXXXTooth discoloration in children younger than 13 years or in developing fetusesXXXPropionibacterium acnes antibiotic resistanceXXXHyperpigmentation in scarsXPseudotumor cerebriXXXVestibular toxicityXLupus-like reaction2XSingle-organ dysfunction2XXXHypersensitivity reaction2XXXSerum sicknesslike reaction||2XXX

Other treatment options:Phototheraphy- blue and red light.Laser treatmentAcne surgeryCortisone treatment: IL injections.Peeling

Side Effects of acneEmotional Distress : Inferiority ComplexPigmentationsAcne scars : Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring. Box car scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars. Rolling scars - Scars that give the skin a wave-like appearance. Hypertrophic scars - Thickened, or keloid scars.Acne Scars

Icepick ScarsBoxcar ScarsRolling ScarsHypertrophic Scars

PROGNOSISOverall, the prognosis for acne is favorable. SOURCEHarahap, M., 2000, Ilmu Penyakit Kulit. Jakarta: Hipocrates.Djuanda A, Hamzah M, Aisah S, editor. Ilmu penyakit kulit dan kelamin. Ed ke-6. Jakarta : Balai Penerbit Fakultas Kedokteran Universitas Indonesia; 2013.Zaenglein AL, Graber EM, Thiboutot DM, Strauss JS. Acne Vulgaris and Acneiform Eruptions. In: Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, eds. Fitzpatricks Dermatology in General Medicine 7th ed. New York: McGraw-Hill; 2008. Dreno B, Poli F. Epidemiology of Acne. Dermatology, Acne Symposium at the World Congres of Dermatology Paris July 2002. Switzerland: Karger AG; 2003Boxton PK. ABC of Dermatology 4th ed. London:BMJ Group;2003.Baumann, M., 2002, Acne. dalam Bauman, L. & Weisberg, E. (Eds.) Cosmetic dermatology principles and practice New York, The McGraw-Hill Companies.Batra, Sonia. Acne. In: Ardnt KA, Hs JT, eds. Manual of Dermatology Therapeutics. 7th ed. Massachusetts:Lippincot Williams and Wilkins; 2007.BMJ Best Practice. Acne Vulgaris. Cited on 14 June 2015. Available from: http://bestpractice.bmj.com/bestpractice/monograph/basics/classification.htmlTruter I. Evidence-based Pharmacy Practice : Acne Vulgaris.SA Pharmaceutical Journal. 2009Wolff K, Johnson RA, Saavedra AP. Fitzpatricks Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York: Mc Graw Hill. 2013;Thieme, S. Clinical Companions Dermatology. USA. Thieme : 2006