Ance Overview
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Transcript of Ance Overview
ACNE Overview
Dr Paul Spano
Cosmetic Physician
ACNE Pathology
• Chronic Inflammation - Pilosebaceous Unit
• Abnormal Keratinizaton in Hair Follicle
• Increased Follicular Epithelial Turnover
• High Sebum Production
• Follicle Blockage = Comedone– Non-Inflammatory
• Propionibacterium acnes – Chemical Inflammation
General Factors
• Diet - Unconfirmed • Cosmetics
• Oil
• Irritation
• Summer• UV light
• Salt water
• Stress• Common Association
• Picking
• Endocrine• Androgens
• PCOS
• Pre-menstrual Flare
• Drugs• Steroids
• OCP
• Occupation• Sweating
• Oils
Aims of Treatment
• Unblocking the Comedones
• Reducing Sebaceous Gland activity
• Reducing Bacterial Count
• Reducing Inflammation
• Cosmesis Short Term - Pimples
• Cosmesis Long Term - Scarring
Treatment
• TOPICAL– Keratolytics
• Salicylic Acid
• Azealic Acid
– Retinoids• Tretinoin
• Adapalene
– Anti-Bacterial• Benzoyl peroxide
• Topical Antibiotics
• SYSTEMIC– Antibiotics
• Antibacterial
• Antiinflammatory
• Resistance
• Side Effects
• eg Minocycline (Dizziness, Ataxia, Pigmentation, Headache)
– Hormones• Cyproterone
– Spironolactone• Antiandrogen
Roaccutane
• 4-6 months oral therapy
• 20% need second course
• Teratogenic
• Side Effects ++++++++
• Linked to Teenage Suicide via Depression and Psychoses
Vitamin A
• Group of compounds
• Cellular differentiaion, organ development and pigment production (retina)
• Immune function, Antiinflammatory
• all Trans Retinoic acid (Tretinoin)
Roaccutane - M.O.A.
• Inhibits Vit. A metabolism in skin • Vit A levels increase by 50% in Epidermis
• Sebosuppressive• 90% red. In gland size, proliferation
• Inhibits Keratinocyte numbers• Less follicle blockage• increased water loss - barrier loss
• Inhibits Bacterial Growth• Antiinflammatory
Roaccutane - Precautions
• Contraindicated• Pregnancy and Lactation• Severe Hepatic or Renal Failure
• Relative Contraindications• Hyperlipideamia• Diabetes• Severe Osteoporosis
• Co-medication• Vit A - Incresed Toxicity• Tetracyclines - Cranial Hypertension• Regular Aspirin/NSAIDS - Mucosal damage
Roaccutane - Adverse EffectsDose Dependent, Reversible
• Cheilitis 80%• Facial Dermatitis 40%• Xerosis (Dry Skin) 40%• Photosensitivity 100%• Dry Mucosa 40%• Conjunctivitis 30%• Epistaxis 25%• I.B.D. • Flare / Scarring ++
• Itching 25%• Skin Fragility 20%
• Waxing, Shaving
• Abrasive therapy
• Desquamation 15%• Hair Loss 15%• Retinoid Dermatitis• Depression / Psychosis
Roaccutane - Adverse Effects 2
• Eyes and Pseudotumour cerebri• Dryness / Contact Lenses
• Corneal opacities, Cataract
• Pseud. C. with Tetracycline
• Lipids and Liver• Hypertriglyceridaemia, Hypercholesterolaemia
• Reduced HDL, Hepatic enzyme disruption
• Arthralgia / Myalgia 5%• Young Adults, can be severe
• +/- Ligament calcification
Roaccutane Adverse Effects 3
• Long Term Toxicity - Bone• Vitamin A intoxication
• > 2 yrs treatment
• hyperostosis, periostosis, demineralization
• premature epiphyseal closure
• Irreversible
• Teratogenicity• OPC 1 month before and 3 months after
• Pregnancy Testing
• Monitoring• LFT , ESR, Glucose, Lipids
Roaccutane cont.
• Links to Teenage Suicide
• Jick Study by Roche to dispel concerns• Poorly designed
• Raised more concerns
• Depression 20% incidence • ? Roaccutaanes role
Modern Treatments
• Microdermabrasion• Crystal Abrasion
• Suction / Oxygenation
• Home exfoliation / AHA / BHA
• Chemical Peels• Keratolytic
• Exfoliants
Remember…….
• Emotional Support
• Complex Disease
• Concurrent Multiple Treatments
• Antibiotic Resistance
• Roaccutane not a Panacea