Acne - A physical change in the skin caused by a disease process in the sebaceous follicle - Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms Types of Acne Comedo, papule, pustule, nodule and cyst. Sebaceous glands: Glands in the skin that produce an oily substance called sebum--these glands are the sites of acne lesions. Sebaceous glands are attached to hair follicles and are found mostly on the face, neck, back and chest. Sebum: The oily substance produced by sebaceous glands.

Classification of Acne Vulgaris Obstructive Acne Open Comedones (Black heads) Closed Comedones (White heads) Inflammatory Acne (in order of lesion formation) PapulePapules PustulePustules NoduleNodules CystCysts Scars

Acne occurs when androgen hormones cause sebaceous glands to grow and produce more sebum. In concert with this change, there are changes in the skin lining the hair follicle to which sebaceous glands are attached. The skin cells of the follicle lining shed more quickly, in clumps, and are sticky. These cells and increased sebum output are likely to cause clogged pores that can become comedones. Finally, a kind of bacteria, P. acnes, which is a normal resident on the skin, invades the clogged follicle and begins to multiply rapidly. The result is acne in all its forms. Mechanism

Drugs used in Acne Isotretinoin Azelaic Acid Clindamycin Topical Erythromycin Topical Tetracycline Topical Benzoyl Peroxide Tretinoin Given the way acne occurs, acne treatments do one or more of the following: Reduce sebum production Reduce P. acnes Normalize the shedding of skin cells Acne Treatment

Isotretinoin Indications Acne Vulgaris Dosing Course: weeks Facial Acne Lower dosing: 1 mg/kg divided bid) Truncal Acne Higher dosing: 2 mg/kg divided bid Consider repeat 4 month course after 2 month rest Indicated for severe, refractory truncal acne Adverse Effects Very Teratogenic (even 1 pill)Teratogen Needs two forms Contraception while takingContraception Counsel extensively before use Cheilitis (90%) Dry or chapped skin (90%)

Dry nose and eyes (80%) Elevated serum Triglycerides (25%) Elevated liver transaminases (15%) Hair shedding (10%) Night blindness Monitoring Serum testing baseline and every 2-4 weeks Liver transaminases Triglycerides

Benzoyl Peroxide Indication Acne Vulgaris Mechanism Comedolytic Kills follicular bacteria Resistance cannot develop Preparations Pure Cream 5%, 10% Gel 2.5%, 5%, 10% Lotion 5%, 10% Combination Benzoyl peroxide with Erythromycin (Benzamycin)Erythromycin Gel 50 mg benzoyl peroxide and 30 mg ErythromycinErythromycin

Application Apply to clean skin each day for 3 days Slowly increase strength of application Later increase time left on skin Adverse Effects May cause skin dryness or irritation Use water based instead of acetone or alcohol product Use Lotion or cream instead of gel Bleaches hair and skin