2. Marketing Department Salikita gel Medical Background

3. Skin Anatomy Stratum corneum Dermis Hair follicle Sebaceos gland Epidermis Hair Shaft Hypo-Dermis Sub-cutanous tissue (Adipose Tissue) Sweat Gland

5. SEBACEOUS GLANDS SEBACEOUS GLANDS The are found in FACEFACE SHESTSHEST BACKBACK SCALPSCALP

6. FUNCTION OF SEBACEOUS GLAND FUNCTION OF SEBACEOUS GLAND Protecting the skin from dryness & harmful sun rays. Lubricates the hair and skin. It reduces the growth of microorganisms anywhere on the skin Sebaceous Glands secrete an oily substance known as Sebum

7. SEBUM SEBUM Sebum is created in the Sebaceous glands through a small duct. it moves up the hair shaft and ultimately arises to the skin surface through the hair follicle. While coming up, it helps to push out any dust particle, germs or skin debris that may have somehow entered into the hair follicle

9. Acne vulgaris is a common disorder of the pilosebaceous unit. It means prevalence in adolescence is estimated to be 70-87%.1 Its cutaneous manifestation is well known to clinicians and have been amply described.

10. Definition: Acne is a Chronic Multi-factorial Disorder of Pilosebaceous follicules Characterized by follicular eruption and polymorphic clinical picture and sometimes accompanied by inflammation and bus production and sometimes not,This is according to it's severity Pathogenesis : 1.Hyper- keratinization. 2.Excessive sebum production. 3.Bacterial Multiplication. 4.Inflammation.

11. Acne Pathogenesis 1.Hyper-keratenization:  Characterized by a strong increase in the production of the follicular corneocytes & increased retention of these corneocytes in both the lower part of the follicle (Infundibulum) & follicular canal.  These corneocytes build up with sebum produced from the sebaceous gland of the pilosebaceous system forming CLUMPS blocking the follicular canal thus forming the Microcomedo.

12. Acne Pathogenesis Accumulation of corneocytes (cells ) of corneocytes (cells ) The sebaceous gland Is clogged: its volume increases. Hyperkeratenization: 1- Hyperkeratenization:

13. Acne Pathogenesis 1.Hyperkeratenization:  If this gives a black-head comedons then the Pilosebaceous pores are opened.  While if it was white-head comedons then the pores are closed. sébum oxydation Open Comedon black Head Closed Comedon white Head

14. 2- Excess Sebum Production ( Seborrhea ): Sebaceous glands and sebum production play a central role in the development of acne. Sebaceous gland is hormonally regulated which in turn affects the pilosebaceous unit. Perhaps the most preformed and well known effect of hormones on the pilosebaceous unit is the one caused by androgens, more specifically: Majority of the circulating androgens are produced by gonads and the adrenal gland, but they are also locally produced, in sebocyte from dehydroepiandrosterone (DHEA) sulfate

15. Androgen receptors are expressed in the basal layer of the sebaceous gland and in the outer root sheath keratinocytes of the hair follicle. 4,5 When free testosterone enters the cell. It is quickly reduced to 5-dihydrotestosterone (5- DHT) by the 5α-reductase enzyme. The activity of 5α-reductase is increased in the sebaceous gland in proportion to the size of the gland. 6. DHT increases the mRNA of proteins involved in fatty acid, triglyceride squalene, and cholesterol synthesis. This effect is mediated by sterol response element binding proteins (SREBP’s). Androgens exert their effect on sebaceous glands by increasing the proliferation of sebocytes and increasing lipid production through SREBP’s. 1. Sebaceous gland enlargement 2. Sebocyte proliferation 3. Lipid metabolism

17. Acne Pathogenesis 2- Excess Sebum Production ( Seborrhea ):  Characterized by Sebaceous Gland Hyperactivity induced by the effect of androgens (testosterone) which affects the sebaceous gland increasing the sebum production.  Due to Hyper- keratinization the sebum become trapped & accumulated inside the pilosebaceous system.  The sebum is very rich in Triglycerides, wax-esters, Cholesterol and Cholesterol-esters.  This medium is very rich in nutrients and suitable for Bacterial growth.

18. 3- Bacterial Multiplication:  Both skin & Sebaceous follicles are colonized by a bacterial flora among which is Propionibacterium Acnes.  This strain is weakly anaerobic Gram +ve.  The medium inside the pilosebaceous become suitable for P.Acne to grow as it become oxygen free & rich in nutrients.  As P.Acne produces Lipase enzyme breaking down the tri-glycerides and producing free Fatty Acids & Biproducts which triggers the inflammation. Acne Pathogenesis

19. 3- Bacterial Multiplication:  Thus P.Acne itself & it's biproducts act as a source for chemo-tactic factors that trigger the inflammatory response & immune reaction.  Also P.Acne by time if untrearted produce enzymes that lyses & dissolve the comedone walls. P. Acnes free fatty acids P.acnes produces free fatty acids : they are irritant Acne Pathogenesis

20. 4- Inflammation : A-The inflammation in acne occurs due to: Chemotactic factors (from P. acnes) Attract Neutrophils Free Oxygen Radicals Inflammation B- The action of lipase enzyme: Which is Secreted from P. Acnes splits the sebum into free fatty acids which are irritant for the skin Acne Pathogenesis

21. 4- Inflammation: Acne Pathogenesis

22. 4- Inflammation:  If the acne remains untreated there severity increases by time and inflammation starts to occur & characterized by : Redness, Oedema, Heat, Pain.  Sometimes the Acne lesions (congested Pilosebaceuos units) rupture due to any mechanical pressure releasing there contents of P.Acne and there Bi- products & all the inflammatory mediators inside them to the surrounding tissues causing inflammatory Acne.  Thus we should avoid pressing them or cleaning them manually other wise the inflammation will increase. Acne Pathogenesis

23. Classification of Acne 1- According to Severity A- Mild B- Moderate C- Severe D- very severe 2- According to type of the lesions Comedonal Acne Papular Acne Pustular Acne Cystic Acne Nodular Acne Acne Conglobata

24. SEVERITY CLASSIFICATION SEVERITY CLASSIFICATION Up to 20 comedones and less than 15 papules Mild Acne 20-100 comedones and/or 15-50 inflamed papules or pustules Moderate Acne More than 5 cysts/nodules, more than 100 comedones Severe Acne severe nodulocystic acne Very Severe

25. CLASSIFICATION CLASSIFICATION INFLAMMATORY PapulesPustulesNodulesCysts Non-INFLAMMATORY Closed Comedones (White Head) Open Comedones (Black Head)

27. Comedonal Acne

28. Papulo-pustular Acne Papulo-pustular Acne

30. Nodular or Cystic Acne

32. * Acne Cosmetica Common form of acne is caused by cosmetics. It can strike anyone — even people who are not physiologically prone to acne. It typically consists of small, itchy or rashy pink bumps on the cheeks, chin and forehead. Developing gradually over the course of a few weeks or months.

33. Steroid induced Acne

34. Acne affects an estimated 80% of humans at some Stages of their lives Occurs in both genders It is more distressing to ladies Egypt 16 – 24 Y. Old = 16,200,000 Human 70% * 16,200,000 = 11,340,000 acne patient

36. Salikita gel Active ingredients Oleanolic acid lactic acid Salicylic acid chamomile Aloe vera Allantoin Avocado Tea tree oil Green tea Panthenol

37. Reduce the efficacy of the 5 α reductase on the Pilosebaceous Unit Decrease the number of active glands Decrease the quantity of sebum production

38. LACTIC ACID Action Dissolve the “glue” that holds the skin cells together  Comedolytic & Keratolytic  Keratoplastic : Normalize the keratinization process  Smooth out fine wrinkle lines  Strong Humectant & hydrating agent  Promotes skin rejuvenation

39. Salicylic Acid It is used in many "anti-aging" creams and acne treatments. ACTION Exfoliates Skin giving Comedolytic & Keratolytic Penetrates the pores more deeply than AHA Controls oil Removes dead skin cells Causing the cells of the epidermis to slough off more readily. Prevents pores from clogging.

41. TEA TREE OIL TEA TREE OIL Anti Bacterial Improves the appearance of the skin Anti Inflammatory

42. TEA TREE OIL TEA TREE OIL has antiseptic properties against wide range of micro-organisms : TEA TREE OIL Staph. aureus Staph. epidermis Propionibacterium acnes

43. Tea tree oil has beneficial medical properties when applied topically, including antiseptic, antibacterial, antifungal, and antiviral action Tea Tree Oil to inhibit respiration and increase membrane permeability in microbial cells Non irritating and highly effective antiseptic. Tea tree oil

44. Allantoin Allantoin Allantoin Keratoplastic Emollient Wound Healing Anti- inflammatory

45. Allantoin is convenient substance for the treatment of acne scar through its properties of stimulating epitelization, providing elastic surface formation and support of physiological scar formation. Allantoin accelerates wound healing, achieves epitelization and has an increasing effect on water binding capacity of tissues

46. Green Tea Extract Green Tea Extract (GT) Sebo- Regulatory Anti-bacterial Photo- protective Anti- inflammatory

47. Green Tea Extract Green Tea Extract

48. The avocado is a Plant cultivated in tropical and Mediterranean climates throughout the world.  It is rich in monounsaturated fat as well as protein.  It is rich in vitamin E, A, D (Anti-oxidants)  Filled with plant steroids Avocado Avocado Avocado oil is rich in sterolins and plant sterols called phytosterols plant sterols have potent Anti-inflammatory properties similar to cortisone. sterols and sterolins was capable of reducing the secretion of pro-inflammatory cytokines

49. AVOCADO Anti inflammatory Moisturizer Demulcent Soothing Rebuild Skin Barrier Wound Healing Avocado Avocado

50. Chamomile topical creams help to relieve inflammation, similar to the function of topical hydrocortisone. Referred as Natural Corticosteroids A clinical trial in Germany found that 2% chamomile cream was nearly as effective as 0.25% hydrocortisone cream Moisturize the skin. Chamomile Chamomile

51. Aloe Vera also is a rich source of amino acids, vitamins A, C, F, B, niacin and traces of Vitamin B12. used in treating skin-related problems. it is a very useful natural element to treat our skin.

52. Provitamin of B5 Turns into pantothenic acid (commonly known as Vitamin B5). It adds essential moisture Provides demulcent & Soothing Effect Provide relief of inflammation Participate in the composition of skin identical lipids

53. Comedolytic Kertaolytic Sebo- regulatory Anti-bacterial Anti- inflammatory Photoprotection Salikita Gel Pilosebaceous units hormonal controller

58. Salikita gel 50 gm. 39 LE