ACNE. Jason M Cheyney, MPAS, PA-C Dermatologic Surgery Specialists Macon, Ga 31211

Transcription

1 ACNE Jason M Cheyney, MPAS, PA-C Dermatologic Surgery Specialists Macon, Ga 31211

2 Pathogenesis of Acne Causative Factors Therapy On the horizon

3 Approximately 45 million Americans have acne It is often the first assault on teenagers ego It can become an overly emotional situation Acne is much worse than a bad hair day Acne can affect ~ 40% of people over 25 y/o Over $100 million spent annually to treat acne

4 Hair follicle plugged by abnormally keratinized cells Increased oil retention by pilosebaceous unit Proprionibacterium overgrowth and digestion of oil and production of free fatty acids Free fatty acids induce inflammation Androgen induced sebaceous gland hyperactivity Diet plays a role with increased carbohydrate intake triggers insulin release which causes excess hormone production

5

6

7 Comedonal (Non-inflammatory) Open = blackheads Closed = whiteheads Papules: Solid inflamed elevations above the skin Pustules: pus-filled inflammatory bumps Nodules: Deeper lesions, often painful and can lead to discoloration and scarring.

8 Inflammatory or Not? - Determines Need for Antibiotics (topical or oral) Depth of the Lesions? - Determines Role of Oral Medication PIH or Scarring Present? - Determines How Aggressive you NEED to Be - Is Patient a Candidate for Isotretinoin? Psychological Impact? - Will Determine How Aggressive to Get

9

10

11

12 Topical Retinoids BPO Antibiotics AHA/BHA Azaleic Acid Dapsone Ivermectin Brimonidine

13 Systemic Antibiotics Doxycycline and Minocycline Spironolactone Isotretinoin Don t let the rumors scare you Has been a life-saver for many patients

14 A Cornerstone of Treatment for All Stages Maintenance Therapy MOA: Normalizes Desquamation of Skin Cells Reduces obstruction in the follicle which reduces P. acnes growth, facilitates the removal of existing comedones, and hinders formation of new lesions and reduces inflammation Adverse effects: skin irritation, worse before better

15 Pea-sized amount to a clean and DRY face Avoid eyelids no breakouts there anyway Wash hands after application Often a period before skin is retinized May get worse before it gets better May get dry with use; use moisturizer If too irritating, use every other day until ready for daily use

16 Mechanism of Action: - Decreases P. acnes (bactericidal) - Comedolysis Preparations: - OTC/RX 2.5% - 10% - Wash, creams, gel, foam, combination products Safety: - Bleaches clothes - Irritation and dryness

17 Retinoid + Benzoyl Peroxide = 3

18 Available by prescription only: Lotion, Gel, Cream Erythromycin, clindamycin, sulfacetamide, metronidazole MOA: Reduces the bacterial population, also possess antiinflammatory properties. Should not be used as monotherapy Increased incidence of bacterial resistance Erythromycin is virtually ineffective at this point Adverse effects: generally mild dermatitis, allergy

19 Available over the counter and prescription in concentrations ranging from 0.5% to 10% for the treatment of Acne vulgaris (higher concentrations are for the removal of warts). Most often found in facial cleansers MOA: Possesses a keratolytic effect and is a mild antiseptic. Adverse effects: erythema, pruritus, burning/stinging sensation

20 Apply up to twice daily Helpful in skin of color due to skin lightening affect Stinging most common side effect

21 Apply twice daily?g6pd Stinging burning can occur

22 Apply once daily Effective against demodex Improvement with continued usage

23 Apply in AM Rebound erythema after hours Significant improvement with continued usage

24 Generally reserved for moderately severe to severe acne Inflammatory acne only (not effective for comedonal acne) Cystic or inflammatory acne resistant to topical treatment Systemic treatment options: Oral antibiotics Isotretinoin Hormonal therapy

25 Isotretinoin Indicated for the treatment of severe, nodulocystic acne Affects RNA synthesis at a cellular level which in turn modifies the cell turnover rate, decreases follicle and sebaceous gland size, and decreases sebum production. Also possesses anti-inflammatory properties. Dose: mg/kg/day x 20 weeks Remission can be permanent after one course of treatment. Use is governed by the ipledge program

26 Tips for Better Outcomes - Used Rx Exactly as Prescribed - No OTC meds unless told to do so - Never pop, squeeze or pick lesions - Avoid using abrasive products - Use hands or gentle washcloth to wash your face - Wait 5 30 min after showering or washing to apply topical medications - It is possible for your acne to get worse before it gets better - Add moisturizer early on in treatment

27 Tips for Better Outcomes Use only oil-free skincare and hair care products This is your condition; It is your responsibility to use meds as directed Apply medications before make-up or facial moisturizers Use only non-comedogenic products Continue to use medications even after skin clears Gently cleanse skin after sweating Give your medications adequate time to work

28 Your Patient Won t Succeed If: Too Many Steps to the Regimen (especially boys) Inadequate Patient Education Unrealistic Expectations Patient Frustration

29 YOU, Make the Call

30 Best Method to Treat Scarring?

31 Don t Let the Redness Fool You!

32 Acne Rosacea Primarily seen in Northern European decent Called the curse of the Celts in Europe 3x more common in women Predominantly seen in caucasions Typically arises between the ages of 30-50

33 Acne Rosacea Cause unknown Sunlight is most common trigger Heat can induce Food Caffeine Alcohol Spicy foods Demodex Feces? Bacteria in Feces?

34 Acne Rosacea Erythematotelangectatic Papulopustular Phymatous Ocular Subtypes Perioral dermatitis

35 Treatment Directed at type Erythematotelangectatic Metrocream Mirvaso Cleocin/hydrocortisone Laser

36 Topicals Metrocream Azaleic acid Ivermectin BPO/clindamycin combo Systemic Antibiotics- low dose Isotretinoin? Spironolactone

37 Isotretinoin Surgery

38 Topical BPO/Clinda combo Metrocream Systemic Antibiotics

39 Blue light Biofilm agents Retinoic acid blockers Cytokine blockers - Th1