4. Acne vulgaris

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1. Acne vulgaris DR. BIJAY KR.YADAV Holly vision technical campus Shankhamul , Kathmandu

2. Acne vulgaris Acne vulgaris is a follicular disorder affecting sebaceous glands of the face, neck and upper trunk characterized by both inflammatory and non-inflammatory lesions. It is the most common dermatoses affecting teenagers. Aggravated form of acne which are large and infected it is called as nodulocystic acne. Incidence :- Peak incidence in late teen age years. (M = 16 – 19 yrs , F = 14 – 16 yrs ) It starts after adolescence and by the age of 25 yrs most patients stop having acne. Both sexes equally affected.

3. Co-factors (Aggravating) P remenstrual UV radiation( Excessive sunlight may either improve or flare acne ) . S tress S weating S moking M echanical or Frictional forces G reasy or occlusive products D iet- high glycemic & milk

4. Etiology :- Causative organism Propionebacterium acnes B. Risk factors : Age – Adolescence (14 - 19 yrs ) Environment – Hot and Humidity Food – Oily food, Spicy food Drugs – Steroids, Anticonvulsant, OCP Others - Emotional and stress factors - Genetics - Poor hygiene

5. Pathogenesis I ncreased sebum production. H yperkeratosis of pilosebaceous duct. C olonisation of duct with propioniform bacteria. I nflammation.

6. G rades of Acne (Pillsburg’s) Grade 1: comedones,( open or closed) occ asional papules. Grade 2: papules, comedones, few pustules. Grade 3: Pre-dominant pustules, nodules, abscesses. G rade 4: mainly cysts, abscesses, scars

7. Acne grading Mild Moderate Severe < 20 comedones , or < 15 inflammatory lesions, or < 30 total lesio ns. 20 to 100 comedones , or 15 to 50 inflammatory lesions, or 30 to 125 total lesions > 5 cysts, or total comedone count > 100, or total inflammatory lesion count > 50, or > 125 total lesions

8. Gade 1; comedones Grade 2: Papules, pustules

9. Grade 3: Papulo-pustules G rade 4: papulo-pustules, comedones, cysts

10. Management General measures : Face wash with warm water 2-3 times a day Avoid spicy food, oc -pills, skin exposure etc. Topical therapy : Topical therapy alone is indicated for mild to moderate lesions a. Mild lesions : Benzyl peroxide 5 % gel, twice daily Topical antibiotics Azithromycin ointment Erythromycin ( 2% lotion & 3% cream) Clindamycin phosphate 1% lotion Tetracycline lotion b. Moderate lesions : Topical Retinoids : Isotretinoin 0.5% cream Salicyclic acid 3-5%

11. Systemic therapy : - In severe acne - Not responding to topical therapy. Antibiotics : Tetracycline : ( most common ) 250 mg 4 times a day taken in empty stomach initially for 4-5 weeks. Followed by maintenance dose of 250-500 mg daily for several months Erythromycin : 250 mg QID for 4-5 wks followed by maintenance dose of 250-500 mgs for several months Doxycycline 100-200 mg Clindamycin 150 mg Azithromycin 500 mg

12. Estrogens : Ethinyl estrodiol 100 mg/day for few months Antiandrogen : cyproterone acetate 50-100 mg/day on 5- 14 day of cycle to enhance the effect of sebum reduction Spironolactone 1 mg /kg/day for facial lesions. 2mg/kg/day for truncal lesions for 15-20 wks.

13. Complications: Post-inflammatory hyperpigmentation. Ice-pick scars Atrophic/ Hypertrophic scars Psychiatric disturbances-depression. Keloids

14. C omplications; Ice-pick scars H ypertophic scar Atrophic scar

15. Conclusion: Acne typically recurs over years and maintenance therapy is an important component of acne management. The preventive effect of topical retinoids and for antibiotic resistance make s topical retinoids ideal. A ny treatment started must be continued for at least 6 wks before changing. Though acne remits with age, scars can be life-long.