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dr. IGA SUMEDHA PINDHA, Sp.KK(K) dr. IGAA ELIS INDIRA, SpKK dr.NLP RATIH V KARNA, SPKK
Lab/SMF Ilmu Kesehatan Kulit dan Kelamin FK UNUD/RS Sanglah Denpasar
characterized by:
comedones (open comedo or blackhead, closed comedone or whitehead), papules, pustules, nodules, and often scars
Pathogenesis
Acne is follicular disease with comedo formation
Comedones reveal: thinned epithelium, dilated follicular canal filled with lamelar lipidimpregnated keratinous material.
Infantile acne : cases that persist after the first 4 weeks of life
ACNE
disease of the adolescent (85% of all teenagers)
Predisposing factors - comedogenic greasy or occlusive products acne cosmetica - mechanical or frictional forces - overexuberant washing - chin straps, violins, hats, surgical tape - acne venenata - drug-induced acne - endocrinologic disorder
Hyperandrogenic state
- woman and children - irregular menses and hirsutism - acne resistant to conventional therapy - relapse quickly after a course of isotretinoin - sudden onset of severe acne
Screening test for virilizing tumor (adrenal tumors, congenital adrenal hyperplasia, ovarian tumor)
- serum testosteron - LH/ FSH ratio (>2-3) - ovulation < 9 periods per year or period >40 days apart - sign of hyperandrogenism
Gradation of acne
Comedonal acne Papulopustular acne Conglobate acne
ACNE CLASIFICATION
KOMEDO MILD MODERATE < 20 20-100 PAPUL/PUSTUL NODUL <15 15-50 <5
SEVERE
>100
>50
>5
Acne neonatorum
Differential diagnosis
1.1. Acneiform eruption Characterized by papules and pustules No comedone Associated to certain drugs glucocorticoid, isoniazid, high dose of vit B complex, phenobarbital, tetracycline, iodides, bromides - Sudden onset - Different distribution to acne vulgaris (Appear on wide distribution)
2. 2.Rosacea
- Chronic eruption of the central face
- No comedones
- Thickened skin of nose (rhynophyma)
3. Perioral dermatitis
- Confined inflammation of perioral & perinasal regions - Predominant in child-bearing woman - No exact etiology (sensitivity of sun exposure, acne, rosacea, infection of candida or demodex folliculorum, misuse of potent topical steroid ) -Clinnical findings : persistent erytheme, scale with small papule and pustules in the perioral and nasolabial regions -There is five millimeter clear zone at the vermilion edge
TREATMENT
- Avoidance of specific foods is not necessary - Scrubbing of the face worsen acne
Medical therapy
1.
2.
Complications
pitted scars
Scarring
keloids
wide-mouthed depressions
amount of melanin type of melamin (eumelanin = brown, pheomelanin = yellow or red) degree of vascularity presence of carotene thickness of the stratum corneum
Melanin is formed from tyrosine, via the action of tyrosinase, in the melanosomes of melanocyte
Pigmentation require
the adequate manufacture of melanin appropriate transport of melanosomes within the melanocyte
The melanosomes are transferred from a melanocyte to a group of 36 keratinocytes called the epidermal melanin unit
Melasma is characterized by brown patches typically on the malar prominences and forehead quite sharply demarcated
MELASMA
Affect darker-complexioned individuals (Fitzpatrick skin types IV and V) Most frequently in young women, men 10%
Pregnancy
Use of dilantin PREDISPOSING FACTORS hormonal : ingestion of estrogen (oral contraceptives or hormone replacement therapy [HRT] at menopause)
Endocrinologic disorders
Melasma classified as
Epidermal based : Dermal based : Mixed :
woods light lesion
Pathology
1. Epidermal type Increasing of melanin disposition on basal, suprabasal and epidermal layers. Vacuolar degeneration in basal cells. Dermal type Perivascular melanin contained macrophag on superfisial dermis and middermis layers Mixed type Both of histologic findings Electron mic. : scattered melanosomes in keratinosit. Dopa staining : increasing of melanocytes count.
2.
3.
Differential diagnosis
Drug induced hyperpigmentation Hyperpigmentation post inflamation Ochronosis exogen Mercury deposition on the skin
Treatment
Gold standard bleaching cream with hydroquinone 2% - 4% Treatment Tretinoin cream increase efficacy
Kligmans formula : combination of hydroquinone, tretinoin and topical steroid Glycolic acid added to hydroquinone to Treatment enhance efficacy
Surgical procedures
peels laser treatment pretreatment with hydroquinone result