Acne - yeabiruh

[ArchivalUser]

pathophysiology----increased adrenal androgens leads to ABNORMAL KERATINIZATION of follicular epithelium with impaction of keratinized cells with the follicular lumen plus increased activity of sebaceous production of sebum and proliferation of propionibacterium acnes >>>>increased formation of free fatty acids by hydrolyzation of sebum triglycerides >>>>>inflammatory reaction

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types of lesions ....

1-Comedones =are non inflammatory=dilated ,epithelial -lined follicular sac filled with keratinoius material ,lipid and bactera=open and closed comedones =closed comedones can be inflammatory much more easily than an open comedones ...

2-Inflammatory papule /nodule=developed from a comedone that has ruptured its content into dermis >>>inflammatory response :if inflammation is close =papule or pustule : if deeper ,a nodule develops . . .

3-Nodulocystic lesions =liquefied masses of inflammatory debris which form from suppuration and giant -cell reaction to keratin and hair

[ArchivalUser]

Acne severity and Rx

1-Mild =open and closed Comedones ,mostly in central face =topical retinoid

2-Moderate=Increased numbers of Comedones ,papules and pustules =topical retinoid plus benzoyl peroxide then topical antibiotic(clindamycin or erythromycin) if no response then pral antibiotic (doxy) if no response

3-Moderately Severe=Many Comedones ,papules ,and pustules with few deeper inflamed nodules ,more extensive involvement of the trunk and shoulders =topical retinoid + benzoyl peroxide + oral antibiotic OR ISOTRETINOIN if no response to the above

4-Severe =Nodulocystic acne =Topical retinoid +benzoyl peroxide +oral antibiotic OR Isotretinoin

[ArchivalUser]

Medication Description

Topical Retinoids are = Anti Comedonal,anti inflammatory,and keratolytic =hence treat the pathophysiology

Benzoyl Peroxide = anti microbial mainly

Topical Antibiotics = anti microbial and anti inflammatory BUT not anti Comedonal

Oral Antibiotics = decrease growth and activity of P.Acnes and are anti inflammatory but not anti comedonal ,not keratolytic

Isotretinoin = Keratolytic ,anti inflammatory ,reduces P.acnes ,anti comedonal,and decreases sebum;TERATOGENIC