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Acne and Rosacea. Dr. D. Czarnecki MD MBBS. Acne. It is a disease of Western societies. Young migrants from the Third World develop acne when they eat the food of their new First World homes. Acne patients who change their diets improve. Starvation will clear acne. Acne.

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acne and rosacea

Acne and Rosacea

Dr. D. Czarnecki MD MBBS

slide2
Acne
  • It is a disease of Western societies.
  • Young migrants from the Third World develop acne when they eat the food of their new First World homes.
  • Acne patients who change their diets improve.
  • Starvation will clear acne.
slide3
Acne
  • Androgens cause the sebaceous glands to enlarge and produce sebum. Acne occurs at puberty.
  • The Western diet affects insulin secretion.
  • Insulin has a direct effect on the sebaceous glands and insulin influences the amount of unbound (free) testosterone in the serum
  • Stress causes the adrenal glands to release more androgens and these aggravate acne.
slide4
Acne
  • Insulin – causes the sebaceous glands to enlarge
  • There is an increase in the amount of free testosterone because of insulin.
  • The increase in testosterone makes the sebaceous glands enlarge, block, and rupture.
  • The contents of the ruptured gland cause inflammation
slide5

Sebum on the skin protects the skin

Androgens

Sebum

Cells produce Sebum

Sebaceous gland

Sebaceous glands enlarge and produce sebum at puberty.

Androgens are the main hormones influencing sebaceous gland metabolism.

Insulin also has an important effect

slide6

Abnormal keratinization

bacteria

Altered sebum

Sebaceous gland

Abnormal keratinization occurs and the sebaceous glands are obstructed.

Bacteria proliferate in the anaerobic environment.

The composition of sebum is altered, it is more likely to cause inflammation.

slide7

Obstruction

Sebum causes inflammation

bacteria

Altered sebum

Sebaceous gland ruptures

Obstructed sebaceous dilate and rupture..

The altered sebum causes inflammation in the dermis.

slide8
Acne
  • Most patients will clear with:
  • AnANTI-INFLAMMATORY ANTIBIOTIC
  • And aCOMEDOLYTIC
  • There is no special facial wash – black heads are caused by compressed keratin, not by dirt
  • No greasy products on the skin or scalp – these will be smeared on the face and can obstruct the glands
  • Consider the anti-acne diet but it will interfere with a normal social life
slide9
Acne
  • Some antibiotics have anti-inflammatory properties. These include:
  • Tetracycline
  • Vibramycin
  • Minomycin
  • Cotrimoxazole
  • Erythromycin
  • The dose must be adequate
slide10
Acne
  • COMEDOLYTICS
  • Remove the obstructions in the sebaceous gland
  • There are several compounds:
  • Benzoyl peroxide
  • Retinoic acid
  • Azelaeic acid
  • Adapalene
slide11
Acne
  • Other effective therapies are:
  • ANTI-ANDROGENS
  • ISOTRETINOIN
  • Acne does not respond to such things as zinc capsules
slide12
Acne
  • Cyproterone acetateis an anti-androgen
  • The dose is 50 mg for 10 days a month
  • (days 5 to 14 of the cycle)
  • The pill should to be taken to keep the
  • cycle regular.
slide14

Cystic acne – this is a bad prognostic sign. Most patients will have acne for decades and be left with many scars

isotretinoin is the most effective drug for cystic acne

slide16
Acne
  • Isotretinoinis the most effective agent
  • The course is for 5 months
  • The dose should be 1 mg per Kg a day
  • The side effects are well tolerated
rosacea
Rosacea
  • A common eruption, more common with age
  • There is inflammation but no obstruction of sebaceous glands
  • Papules, pustules, diffuse erythema, and possible induration of the affected area
  • No black heads
rosacea1
Rosacea
  • Rosacea looks like acne but it is caused by
  • leaking blood vessels
  • Treatment consists of:
  • ANTI-INFLAMMATORY ANTIBIOTICS
  • in anADEQUATE DOSEMetronidazole is effective
  • Topical antibiotics are not very effective
  • Protection from the sun – UVL aggravates it
slide19

Acne – sebum in the skin causes inflammation

Sebaceous gland ruptures

Rosacea – blood vessels leak

rosacea like eruption
Rosacea-like eruption
  • Fluorinated steroids used on the face for long periods cause a rosacea like eruption.
  • Only use 1% hydrocortisone on the face for long periods.
  • Treatment –
  • ANTI-INFLAMMATORY ANTIBIOTICS
  • in anADEQUATE DOSE
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