Dr.Ahmed Abdul-Aziz Ahmed Assistant Clinical Professor Dermatology&Venerology. F.I.B.M.S.

Acne

How a Pimple Forms(1) A hair follicle is surrounded by sebaceous glands, which excrete sebum to the surface of the skin.

How a Pimple Forms (2) Excess oil, unshed skin cells, and natural bacteria within the skin become sticky and create a plug around the hair follicle.

How a Pimple Forms (3) As more sebum is produced in the plugged hair follicle, the, swelling occurs and appears on the surface of the skin. Overall, this pimple-appearing process takes 2-3 weeks.

Comedonal

Variation of Acne Severe Moderate Light Characterized by whiteheads, blackheads, papules, pustules. Inflammatory increases and becomes more serious. It usually happens on surface but sometimes have deeper pustules. Characterized by cysts and nodules, many are in the body, scars are easily formed. Severe Moderate Light

Acne Classifications: Comedonal (mild) acne Inflammatory (moderate) acne Nodular cystic (severe) acne Acne is most common in teenagers, but it can occur at all ages. The condition usually begins at puberty and may continue for many years. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate the sebaceous (oil producing) skin glands. Other hormonal changes related to menstrual periods, pregnancy, birth control pills, or stress can also aggravate acne. Acne is caused when glands within the pores of the skin become plugged, because oil and skin cells accumulate faster than they can exit. The plug causes the hair follicle to bulge (causing whiteheads), and the top of the plug may appear dark (causing blackheads). If the plug causes the wall of the follicle to rupture, the oil, dead skin cells, and bacteria found normally on the surface of the skin can enter the skin and form small infected areas called pustules (also known as pimples or "zits"). If these infected areas are deep in the skin, they may enlarge to form firm, painful cysts. Acne commonly appears on the face and shoulders, but may extend to the trunk, arms and legs. Acne is not caused by dirt or by masturbation or other activities, but dirt and oil on the face can aggravate the condition. Other factors that increase the chances of acne are hormonal changes, exposure to weather extremes, stress, oily skin, endocrine disorders, certain tumors, and the use of certain drugs (such as cortisone, testosterone, estrogen, and others). Acne is not contagious. It tends to run in families. A tendency to have acne may persist through ages 30's to early 40's. Whiteheads (comedo) vs. blackheads (comedons or open comedos)

Whitehead and blackheads

The seborrhoea, comedones and scattered inflammatory papules of teenage acne.

CLOSED COMODOME

OPEN COMODOME

PAPULAR ACNE

PUSTULAR ACNE

Closed comedones (whiteheads) (a whitehead): Accumulation of sebum converts a microcomedo into this.

Closed comedones (whiteheads)

Open comedo (blackhead) (a blackhead): when follicular orifice is opened + distended. Melanin + packed keratinocytes + oxidized lipids  dark colour

Open comedo (blackhead)

Acne vulgaris Inflammatory papules, pustules, crusting on the forehead, cheeks, and chin.

Acne vulgaris Comedones rupturing into the dermis give rise to an intense inflammatory response with pustule and abscess formation (so-called“cystic” or nodulocystic acne).

ACNE CONGLOBATA

Prominent and inflamed cysts are the main features here.

Cysts

Acne Conglobata

Cystic acne – this is a bad prognostic sign 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

Infantile acne

Infantile acne. Pustulocystic lesions on the checks.

Infantile Acne

A group of open comedones (blackheads) following the use of a greasy cosmetic.

Steroid-induced acne in a seriously ill patient.

Warn the patient that staining may be left. This will fade overtime.

Acne scarring: worth treating a test area with a resurfacing laser

ICE PICK SCAR

THUMBPRINT SCARS

ATROPHIC SCARS

HYPERTROPHIC SCARS

KELOIDS

Rosacea

Typical rosacea with papules and pustules on a background of erythema Typical rosacea with papules and pustules on a background of erythema. Note he also has a patch of scaly seborrhoeic eczema on his brow.

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

Inflammatory rosacea Papules and pustules are characteristic

Rosacea

Rosacea Typical moderately severe involvement with confluent erythematous papules and pustules on the forehead, cheeks, and nose. Note the absence of comedones that are typically seen with acne vulgaris.

Inflammatory rosacea

Marked rhinophyma

Rosacea Rhinophyma

Acne vs. Rosacea acne rosacea

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