DISORDERS OF SKIN ADNEXA

-SEBACEOUS GLAND ACNE VULGARIS

-ECCRINE GLAND
- MILIARIA
-APOCRINE GLAND - MILIARIA APOKRIN

Acne vulgaris

Acne vulgaris
Is it important or just
Trivial ?
Is it a disease ?
INSURANCE ?

MOST FREQUENT QUESTION

DIET CHOCOLATE
-SPICY
-FRIED FOODS
-MILK
STRESS

Why it is important serious disease

1. The morbidity - the prevalence
85% 95% (100%) teenager
adult acne- women > 21th
-the most common dermatologic
disorder in US
2. The embarrasing disease
3. The cost - skin care
- treatment of complication - scar

Prevalence

( 85 %) mild
( 15 %) need medical treatment

PREVALENCE
-THE MOST COMMON VISIT DERMATOLOGIST AGE 15-45
-MAN > WOMAN ------- VISIT OF WOMEN 80% > FREQUENT
> AGE 19 YRS
-US DATA PRESCRIPTION ANTIBIOTICS $ 5 MILLION
ISOTRETINOIN $ 1.4 MILLION

PATHOGENESIS:

ANDROGEN

5ar

MICROCOMEDONE

DHT

IL-1
ABNORMAL KERATINIZATION
INFLAMMATION
RUPTURE FOLLICLE WALL

LIPASE
P.ACNE
SEBUM SECRETION

PATHOGENESIS:
THE DEVELOPMENT
OF ACNE LESSION

MICROCOMEDO

INFLAMMATION
LESSION

CLINICAL SIGN:

PRIMARY LESSION
COMEDO
1.OPEN
2.CLOSED

ACNE VULGARIS
DEFINITION:
1. CHRONICALLY INFLAMMATION OF
SEBACEOUS FOLLICLE
2. LESSION COMEDONE-PAPULE-PUSTULENODULE-CYST-SCAR (PLEOMORPHIC)
3. PREDILECTION SEBORRHOIC AREA
4. AGE -PUBERTY

CLASSIFICATION
-PREDOMINANT LESION COMEDONAL, PAPULAR,
PUSTULAR, CYSTIC
-GRADING-MILD, MODERATE, SEVERE
-NUMBER OF LESIONS
-SUBTYPES-CONGLOBATA,NEONATAL,INFANTILE,
MECHANICA, PERIORAL, DRUG INDUCES,
HIDRADENITIS, KELOIDAL

DIAGNOSE OF ACNE VULGARIS:

1. PREDILECTION
2. LESSION
3. SEBORRHOE
4. TEENAGE

CLINICAL VARIATION:

NEONATAL ACNE

ADULT ACNE

ACNE IN COLORED SKIN

TETRAD ACNE

SUBTYPES OF ACNE:

CYSTIC ACNE

SUBTYPE ACNE :

ACNE FULMINAN

SUBTYPES ACNE:

MECHANICAL ACNE
ACNE COSMETICA POMADE ACNE

DIFFERENTIAL DIAGNOSIS:

ROSACEA

DIFFERENTIAL DIAGNOSIS:

ACNEIFORM ERUPTION
* CORTICOSTEROID
* INH
* BROMIDE. IODIDE
* PHENYTOIN

DIFFERENTIAL DIAGNOSIS

PERIORAL DERMATITIS

DIFFERENTIAL DIAGNOSIS:

GRAM NEGATIVE FOLLICULITIS

SIDE EFFECT
CORTICOSTEROID

TREATMENT:
ANTI -ANDROGEN
ABNORMAL KERATINIZATION

RETINOIC ACID
INFLAMMATION

P.ACNE

ANTI INFLAMMATION

ANTIBIOTIK

SEBUM SECRETION

TREATMENT OF
OF ACNE
ACNE VULGARIS
VULGARIS
TREATMENT
OTC
OTC

KERATOLYTIC
KERATOLYTIC
MILD
MILD
NON INFLAMASI

AZELEIC ACID
ACID
AZELEIC

TRETINOIN
TRETINOIN
BENZOIL PEROXIDE
PEROXIDE
BENZOIL

MODERATE
MODERATE
INFLAMASI

TOPICAL ANTIBIOTIC
ANTIBIOTIC
TOPICAL

SYSTEMIC ANTIBIOTIC
ANTIBIOTIC
SYSTEMIC
SEVERE
SEVERE
ANTI INFLAMMATION
INFLAMMATION
ANTI

HORMON
HORMON
VERY SEVERE
SEVERE
VERY

ORAL ISOTRETINOIN
ISOTRETINOIN
ORAL

TREATMENT:
INFLAMMATION
TOPICAL
= ACNE NONINFLAMMATION
BENZOIL PEROKSIDE
ANTIBIOTIC
SYSTEMIC
ANTIBIOTIC
ANTI INFLAMMATION
HORMON

TREATMENT:
NON INFLAMMATION
TOPICAL
KERATOLYTIC
COMEDOLYTIC
BACTERICIDAL

RECENT THERAPY:
PHYSICAL THERAPY -CHEMICAL PEELING
-CRYO SURGERY
-PHOTOTHERAPY
-LASER
NEW DRUGS DERIVATIVES TRETINOIN
-ISOTRETINOIN
-ADAPALENE