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Back to Medical School 18th October 2012 - Acne
The acne disease pathway 1 Androgen hormone influences and stimulates sebaceous gland Sebaceous glands enlarge Excessive sebum production Over production of epithelial cells lining follicles Hyperkeratinization 2 Microcomedone formation A thick hyperkeratotic plug Scars 3 Inflammation and immune response Formation of pustules and cysts Propionibacterium acnes colonization in anaerobic environment Pathogenic factors of acne Excessive sebum production Hyperkeratinization (abnormal cell turnover) Inflammation and immune response P. acnes colonization Goal of treatment: To target as many pathogenic factors of acne as possible 4 White heads and black heads form
Actions of Anti-Acne Therapies • Topical retinoids • and naphthoic acid • derivatives: • Normalize desquamation • Reduce inflammatory response • Benzoyl • peroxide: • Kills microorganisms • Keratolytic • Oral Isotretinoin: • Reduces sebum • Normalizes desquamation • Inhibits P acnes • Reduces inflammatory response • Antibiotics: • Kills microorganisms • Reduce inflammatory response • Hormones: • Reduce sebum production
Skin care for acne patients • No need to overdose on cleansing! • Soap free cleansing/soap substitute washes • Use non-comedogenic cleansers, make up and moisturisers (oil free) • Avoid greasy products • Educate re squeezing and associated scarring
When to Refer Criteria for referral • Severe nodulo-cystic acne (refer immediately) • Risk/evidence of scarring and post-inflammatory hyperpigmentation (PIH) • Moderate acne that has failed to respond to 2 or more courses of treatments • Mild to moderate acne in patients who have extreme psychological distress Galderma Nurse Team