anti acne Flashcards
Common dermatological disorder of the pilosebaceous unit
acne
Sebaceous gland attached to a hair follicle
acne
- Sebum
- Androgens
- Hyperkeratinization
- Propionibacterium acnes
- Inflammation, immune reaction
contributing factors to acne
contributes to increased sebum
androgens
Excess keratin is not sloughed off
Hyperkeratinization
Accumulation of keratin and sebum provide a good medium for P. acnes
proliferation
Propionibacterium acnes
P. acnes is a bacteria → Immune response → Inflammation
inflammation, immune reaction
- Early comedo
- Later comedo
- Inflammatory papule/pustule
- Nodule/cyst
pathogenesis
- Hyperkeratosis and ↑ corneocytes cohesiveness
in the upper sebaceous follicle, which lead to
microcomedo formation - Androgen stimulation of sebum production
Early comedo
- Accumulation of shed keratin and sebum
- Formation of whorled lamellar concretions
Later comedo
Comedo may be:
- Closed/whiteheads (no obvious follicular opening)
- Open/blackheads (dilated follicular opening; keratin plug darkens due to oxidized lipids & melanin)
- P. acnes proliferation, which upregulated innate immune responses (e.g. via TLRs)
- Mild inflammation (primary neutrophils), which increases upon rupture of the comedo wall
- Sebaceous lobule regression
Inflammatory papule/pustule
- Marked inflammation (primarily T cells)
- May lead to scarring
Nodule/cyst
Types of acne
- non-inflammatory lesions
- inflammatory lesions
Consists of open and closed comedones, which are not inflamed and red because follicle walls are intact
NON-INFLAMMATORY LESIONS
- Known as open comedones
- Follicles that have wider openings filled with sebum and dead cells
- Dark color caused by exposure of the top of the comedo to oxygen (oxidized)
Blackheads
- Known as closed comedones
- Follicle opening is closed, and have normal skin color
>Traps dead cells and sebum - More likely to progress into inflammatory lesion
Whiteheads
- Closed comedo becomes larger and packed due to
debris and inflammation from P. acnes - When follicle ruptures, white blood cells and red blood cells migrate to contain rupture, and lesion turns red
INFLAMMATORY LESIONS
INFLAMMATORY LESIONS
- Papules
- Pustules
- Nodule
- Cyst
- First stage of severe acne
- Primary inflammatory lesions
>Slightly inflamed - Small, raised, usually red, and tender bumps under the skin
>Tender bumps - slight pain with touch
Papules
- Also called pimple
- Red, tender bumps with white pus at the tip
>Pus - presence of bacteria
Pustules
Deep lesion that are hard to touch, more painful, and deep red, or purple in color
Nodules
- Large pus-filled lesion resulting from severe
inflammatory reaction - Final stage
- May leave scars
Cyst
Grading of Acne
- Mild acne
- Moderate acne
- Severe acne
- Limited to face
- Characterized by presence ofnon-inflammatory closed and open comedones with few inflammatory lesions
Mild acne
- Increased number of inflammatory papules and
pustules on the face and affects other body
parts
>Back, neck, and chest area also
Moderate acne
- Presence of nodules and cysts
- Facial lesions accompanied by widespread disease on the neck, chest, and back
Severe acne
TOPICAL TREATMENTS
- Benzoyl peroxide (BPO)
- Salicylic acid (SA)
- Resorcinol and sulfur
- Topical retinoids
- Topical antibiotics
- Azelaic acid
- Non-antibiotic antimicrobial agent that kill bacteria by producing reactive oxygen species within clogged pores
> oxidation reaction - Increases cell turnover, cleans pores, desquamates skin, and has anti -inflammatory properties
- Mainstay treatment of mild to moderate acne, in combination with antibiotics and/or retinoids
- Topical OTC at 2.5 to 10% concentration as creams, gels, lotions, and facial wash
- Irritation resolves with continued use trying 1st
month of treatment
Benzoyl peroxide (BPO)
- Peeling - important to use sunblock to protect the skin
- Dryness,
- Burning,
- Redness of the skin
Side effects of Benzoyl peroxide (BPO)
- Can be used in cosmetics (depends on concentration); known as beta hydroxy acids
- Desquamation and comedolytic properties
- Less potent and better tolerated than topical retinoids
- OTC products at concentrations of 0.5 to 2% as lotions, creams, foams, facial wash gels, toners,
and cleansing pads - Peeling occurs because it desquamates
Salicylic acid (SA)
- Skin dryness,
- Redness,
- Scaling,
- Itching,
- Burning
Salicylic acid (SA)
side effects
- Available as creams, masks, ointments, and soap bars
- Can also cause peeling (sulfur cannot cause
peeling) - Sulfur - antibacterial
Resorcinol and sulfur
- Vitamin A derivatives that normalize abnormal desquamation in sebaceous follicles, decrease
coherence of follicular keratinocytes, and
prevent formation of new microcomedones - May be used as monotherapy for the
management of mild noninflammatory
comedonal acne with maximum benefit after 3
to 4 months, and as maintenance therapy - Include tretinoin, adapalene, tazarotene (drugs)
- Prescription drug available as cream, gel, liquid, and microsphere formulations
- Negative effects can be prevented by using lower concentrations of active ingredients or modifying the vehicle
retinoids
- Transient skin irritation
- Burning sensation,
- Redness,
- Itching, and
- Peeling
side effects of retinoids
- Used for mild or moderate acne with inflammatory lesions
- Include clindamycin and erythromycin
- With bacteriostatic and anti-inflammatory
properties - Available as gels, creams, lotions, foams,
toners, and pads - Continuous use can cause bacterial resistance
Topical antibiotics
- BPO/Benzoyl Peroxide (minimize bacterial resistance) and
- Retinoids (synergistic comedolytic and anti-inflammatory properties)
Combined with topical antibiotics
- Considered as a drug
- Alternative to retinoids
- With comedolytic, antimicrobial, and anti-inflammatory properties
Azelaic acid
- Oral antibiotics
- Hormonal therapy
- Isotretinoin
SYSTEMIC TREATMENTS
- With antimicrobial and anti-inflammatory effects
- Include doxycycline, minocycline, tetracycline,
and erythromycin
Oral antibiotics
- Upset stomach,
- Dizziness, or
- Skin discoloration
Side effects of oral antiobiotics
may cause sun sensitivity
Doxycycline
can cause teeth discoloration
Tetracycline
can cause skin
hyperpigmentation
Minocycline
- Adjunct therapy in women with moderate to severe acne
- Reduces and/or prevents outbreaks, but not effective for existing lesions
>Can be combined with topical products to address existing lesions
Hormonal therapy
- Combination oral contraceptives suppress ovarian androgen production
- Androgen receptor blockers block effect of androgens on the sebaceous
gland (spironolactone, cyproterone, and flutamide)
Hormonal therapy
- Headache,
- Breast tenderness,
- Nausea
- Depression
Side effects of hormonal therapy
- Heart disease,
- High blood pressure,
- Blood clots
increased risks of
- Diff from tretinoin (all-trans retinoic acid)
- Oral retinoid for treatment of moderate to severe acne that does not respond to other treatments
>last line therapy - Targets all major components in acne
development, and may be used as monotherapy
Isotretinion
- Dryness of skin, eyes, mouth, lips, and nose;
- Itching;
- Nosebleeds;
- Muscle aches;
- Sun sensitivity;
- Poor night vision
Side effects of isotretinoin
May increase:
- Blood levels of triglycerides
and cholesterol
- Liver enzyme levels
Teratogenic
- cause malformation of developing fetus
Isotretinion
- Chemical peels
- Comedo extraction
- Optical therapies
- Herbal and alternative therapies
- Dietary restriction
OTHER TREATMENTS
- AHAs desquamate the SC and give a smoother
appearance - Glycolic acid has moderate growth inhibitor and
bactericidal effect on P. acnes
Chemical peels
By squeezing with fingertips and using a comedo extractor
Comedo extraction
Exposure to electromagnetic radiation to facilitate treatment
Optical therapies
- Broad-spectrum continuous-wave visible light,
- Intense pulsed light,
- Pulsed dye lasers,
- Photodynamic therapy (PDT),
- Pulsed diode laser
Optical therapies
- Aloe vera,
- Fruit-derived acids, and
- Tea tree oil
Herbal and alternative therapies
- Less oil
- Dairy
- Added sugars
- Peanuts
dietary restrictions
- Use all of the medicine in your treatment plan
- Reduce acne flares with gentle skin care
- Keep all follow-up appointments with your
dermatologist - Follow your maintenance plan
4 WAYS TO REDUCE HOW LONG YOU TAKE AN ANTIBIOTIC
