Acne Rosacea

Most common in people age 30-60 Cause of vascular dilation unknown Initial symptom is erythema of the face Treat symptoms

Topical antibiotics and benzoyl peroxide Tretinoin & oral Abs for persistent Sx

Pathogenesis 4 factors
Hyperkeratosis Increased sebum production Propionibacterium acnes present in the follicle Inflammation

A zits a zitright?

Open comedo = blackhead

Follicle is open and distended Dark color is due to melanin, lipids, and keratinocytes

Closed comedo = whitehead

Progresses from microcomedo due to sebum production

Closed Comedo

Open Comedo

Open comedones

Inflammatory lesions
Pustules (superficial), papules, nodules Develop when follicular contents rupture into surrounding dermis

papules

What about adults?

Acne tends to resolve in the 3rd decade

Due to DHEA decline Premenstrual flares are common in older women

What was that about DHEA?

Androgens in general are the original culprit

Leads to pubertal production of sebaceous glands and sebum Also, some androgens are active on the skin leading to increased metabolic activity in acne-prone areas of the skin

Acne medicamentosa
acne fulminans acne conglobata

External factors

Acne comsetica
Recommend water-based products

Acne mechanica
Mechanical trauma may lead to inflammatory lesions Sports induced

External factors

Clothing can harm

Pts with acne should avoid occlusive clothing

Environmental factors
Humidity & heavy sweating, halogenated hydrocarbons from industrial products (cutting oils, herbicides, chemical warfare)

Dietary factors are usually not of concern

Clinical presentation

Affects face, neck, chest, upper back, upper arms

Greatest number of sebaceous glands

Scarring and hyperpigmentation may occur

Diagnostic evaluation

Refer for endocrine evaluation to rule out systemic causes

PCOShyperandrogenism

Check med list

May be caused by androgens, corticosteroids, lithium, phenytoin, B vitamins, etc.

Diagnosis
Focus on type & location of lesions, scarring, & postinflammatory pigment changes Hirsutism or virilization warrants further lab & imaging studies

Keys to Clearing Acne

Controlled not cured

Patient must want to comply
Takes 4-8 weeks to see full effect

Long-term, consistent and continuous

Type of acne to self treat

Non-Inflammatory (less than 10 comedones)

goals
unblock ducts and keep orifice open relieve social and physical discomfort

When to Refer
Moderate to severe papular, postular and nodule acne (10-25 inflammatory lesions) Scars On chest or back Not typical age Due to Medication use

Non Pharmacological

Cleanse the skin

warm water, soap, not vigorous

Minimizing factors
avoid friction causing clothes no oil based cosmetics sun exposure dont pick or squeeze

OTC products

Benzoyl Peroxide
Salicylic Acid Sulfur (w/ resorcinol)

Benzoyl Peroxide

Bacteriocidal against P. acnes

Increase sloughing of skin cells Prevents closure of orifice

Use 1-2 times daily (4-6 weeks for full effect)

Benzoyl Peroxide

Excessive dryness, peeling

May bleach clothes, bedding Category III (not enough data)

Salicylic Acid

Mild comedolytic agent

surface keratolytic Apply 1-3 times daily

Sulfur

Keratolytic
Comedolytic use 1-3 times daily color and odor

Product selection

Gels vs. Creams

Strength

Questions