JERAWAT / ACNE

Lembaga Estetika Medik Indonesia

Patogenesis
 Penyumbatan duktus polisebaseus.
 Meningkatnya produksi sebum.
 Perubahan biokimia susunan lemak-
lemak permukaan kulit/perubahan
lipd bilayer.
 Kolonisasi kuman didalam folikel
polisebaseus.( P acne makannya
sebum )
 Proliferasi folikuler ( karena keratinosit
nempel kual tidak bisa lepas)
 Inflamasi
Penanganan acne
Penanganan dilakukan sesuai
penyebab/ patogenesis
Penyumbatan duktus polisebaseus.
Menyingkirkan sumbatan dengan
 Retinoid
 Salicilic acid(BHA),
 AHA(lactid,Glycolic,azeleic acid)
BHA more efective reducing
number of comedo than AHA
azeleic acid
5 STep
1.Normalizing
keratinization/exfoliation
Product that blocks step1
( Retinoid)
tretinoin,adaphalen,tazarotene,
retinol,retynil linoleate,retinyl
palmitat,
oral retinoid:iso tretinoin (if
needed)
2. Eliminating/ reducing P. Acne
topical antibiotic:clinda,eritro solution,
combination with BPO/clinda,eritro
Azeleic acid
sodium sulfacetamide
sulfur
oral antibiotik
light therapy
3. Removing material that clogs the
pores (comedolitik)
 Retinoid
 Salicilic acid(BHA),
 AHA(lactid,Glycolic,azeleic acid)
BHA more efective reducing number
of comedo than AHA
azeleic acid
4. Attacking the inflamatory respons
salicilic acid (OTC,acne
wash,lotion,gel,mask)
in office BHA peels
oralNSAIDs
anti inflamatory agents : aloe
vera,chamomile,coenzym Q
10,cucumber extract,
feverfew,green tea,licorice
extract,niacinamide,
5. Decreasing level of sebum
oral kontraseptive,retinoid

Other
Pepaya  enzim papain proteolisis
dari keratin
Clay  mengurangi produksi sebum
Aloe and ice twice daily ( anti
inflamatory, opens stratum
corneum)
 A normal follicle looks like this:
 85 % : 12-25 th
 15 % s/d 35 th
Mitos akne
 Penyakit remaja hilang sendiri
 Masalah kosmetika saja  its no
big deal
 Makanan
 Stress
 Higiene yang kurang baik,
 Make up
 Acne dapat sembuh
Pembagian Acne
 Ringan
non inflamasi, komedo, milia.
 Sedang
inflamasi +
 Berat
Nodulocystic
 Major Oral Antibiotics Used for Treatment of Acne
Vulgaris by Dermatologists in The United State
Drug Usual dosage range Comments Refs

Minocycline 50-100 mg once or Vestibular reactions may be 11,19-

(Immediate twice daily dose related and may be more 22,26
release) common with immediate-
release formulations (especially
generic formulations with rapid
release properties.

Minocycline 1 mg/kg/day (45- Efficacy comparable to 2 17,18

(extended 135 mg once daily) mg/kg/day and 3 mg/kg/day:
release) potential for vestibular
reactiones appear to be lower
than with immediate-release
formulations

Doxycycline 75-100 mg once or Photosensitivity reported to be 19-22, 26

twice daily 150 mg dose related (higher potential
once daily. at 100 mg/day)
 Recommended Laboratory Evaluations For Patients With Acne and
Possible Hormonal Abnormalities

Labs to be considered when evaluating a patient with androgen excess

 Dehydroepiandrosterone Sulfate (DHEAS)
 Follicle-stimulating Hormon (FSH)
 Luteinzing Hormone (LH)
 Prolactin
 17-Hydroxyprogesterone
 Androstenedione
 Free and total testosterone
 Sex Hormone-binding globulin
In a patient where polycystic ovarian syndrome (PCOS) is
A consideration, add:
 Fasting insulin
 Fasting lipids
In a patient where cushing’s syndrome is considered, add Midnight salivary
cortisol level (new test approved by FDA)
Sebaceus hiperplasia
siringoma
Ringan
Sedang
Berat
 Penatalaksanaan acne

 Preventif
 Kuratif
Tata laksana acne

 Perawatan kulit (Skin care)

 Nasehat makanan
 Medikamentosa
Pembersihan
 Cleansing
 Facial Wash
 Toner

 Yang mengandung bahan

antiseptik atau obat – obatan
 Tea tree, klorofil, BPO, Antibiotik,
Sulfur
 Gentle cleansing 2-3 x sehari
 Medicated cleaser (BPO/SA)
 No overcleasing
 No picking
 Put an ice and aloe twice daily
Ingredients in OTC products
 Sulfur; precipitated or colloidal, 2-10 %
other forms, such as zinc sulfide or
sodium thiosulfate, are milder. Sulfur
presents a paradox in that it helps
resolve formed comedones but may
promote the formation of new ones.
Due to this comedogenic effect, the
use of salicylic acid or resorcinol is
preferred.

 Resorcinol and salicylic acid;

Cleansing solution
 Acid salicyl 2
Resorcin 2
Biboras natricus 4
Spirt. Camphoratus 5
Aqua rosarum 140
Spirt. Dilutus ad 200
Acne Lotion
 Asam salisilat
 Resorsinol
 Sulfur praecipitatum
 Tea tree
 Antibiotika
 Minyak terpen
Sediaan Krim
 Tretinoin
 BPO
 Antibiotika
 Kortikostreroid
 Sulfur
 Asam salisilat
Sediaan Oral
 Antibiotika
 Kortikostreroid
 Isotretinoin
 Zn Gluconas
 Vitamin A
Pengobatan
 Retinoid
oral : isotretinoin 0.5-1 mg/kgBB/hr
dosis kumulatif 120 mg.kbBB
mini dose < 0,5 mg/kgBB/hr
( eg 10 mg/hr)
Topikal tretinoin ( krim, gel, sol)
0.025%, 0.05 %, 0.1 %
adapalene ( gel ) 0.1 %, o.3 %
Therapy management of
Retinoid
 Starting dose : 0.25-0.5 mg
/kgBW/day for 2 weeks
 STOP !!! After 4-6 weeks, continous
topical tretinoin
 Antibiotik
oral tetrasikin  doksisiklin 50-100 mg,
2x/hr
minosiklin 100-200mg/hr
Klindamisin
Eritromisin, Azitromisin
Topikal : klindamisin 1 % ( gel,sol )
eritromisin 1,5-2 % ( gel,sol)
kombinasi + BPO
 Azeleac acid ( krim , gel ) 15 % , 20
%- memperbaiki keratinisasi &
mencegah kumulasi p acne...anti
inflamasinya masih diragukan
 B PO ( cuci muka, gel,sol) 2,5-5 %
 mencegah kumulatif p acne
 Hanya retinoid dan antibiotika
yang bersifat anti inflamasi dan
me<< koloni P.Acne
 Komedo (open/closed)  topikal
keratolitik , topical retinoid
 Inflamasi ( papul, pustule) : topikal
BPO,topikal AB, topikal retinoid
 Nodulocystic : all topical
inflamation + oral tretinoid
 Resep oral anti acne (1)
 Acne lotion
S ue
 Benzoil peroksida 5 %
S sore hari
 Vit C 100 mg
Vit B compl 1 tb
Zn Gluconas 100 mg
S 3 dd 1
 Vitamin A 20.000 IU
S 1 dd 1
Resep oral anti acne (2)
 Tetrasiklin 500 mg
S 4 dd 1 ac
 Yeastafort
S 3 dd 1
 Vitamin A 20.000 IU
S 1 dd 1
Resep oral anti acne (3)
 Doksisiklin 100 mg
S 1 dd 1
 Interhistin 50 mg
Medrol 4 mg
S 3 dd 1
Resep oral anti acne (4)
 Clindamisin 300 mg
S 2 dd 1 ac
 Loratadine 5 mg
Prednison 5 mg
S 2 dd 1
Kortikostreroid (KIL)
Terima kasih