1. Acne and Rosacea Dr. D. Czarnecki MD MBBS

2. Acne It is a disease of Western societies.It is a disease of Western societies. Young migrants from the Third World develop acne when they eat the food of their new First World homes.Young migrants from the Third World develop acne when they eat the food of their new First World homes. Acne patients who change their diets improve.Acne patients who change their diets improve. Starvation will clear acne.Starvation will clear acne.

3. Acne Androgens cause the sebaceous glands to enlarge and produce sebum. Acne occurs at puberty.Androgens cause the sebaceous glands to enlarge and produce sebum. Acne occurs at puberty. The Western diet affects insulin secretion.The Western diet affects insulin secretion. Insulin has a direct effect on the sebaceous glands and insulin influences the amount of unbound (free) testosterone in the serumInsulin has a direct effect on the sebaceous glands and insulin influences the amount of unbound (free) testosterone in the serum Stress causes the adrenal glands to release more androgens and these aggravate acne.Stress causes the adrenal glands to release more androgens and these aggravate acne.

4. Acne Insulin – causes the sebaceous glands to enlargeInsulin – causes the sebaceous glands to enlarge There is an increase in the amount of free testosterone because of insulin.There is an increase in the amount of free testosterone because of insulin. The increase in testosterone makes the sebaceous glands enlarge, block, and rupture.The increase in testosterone makes the sebaceous glands enlarge, block, and rupture. The contents of the ruptured gland cause inflammationThe contents of the ruptured gland cause inflammation

5. Androgens Sebaceous gland Sebum on the skin protects the skin Sebum Sebaceous glands enlarge and produce sebum at puberty. Androgens are the main hormones influencing sebaceous gland metabolism. Insulin also has an important effect Cells produce Sebum

6. Sebaceous gland Abnormal keratinization bacteria Abnormal keratinization occurs and the sebaceous glands are obstructed. Bacteria proliferate in the anaerobic environment. The composition of sebum is altered, it is more likely to cause inflammation. Altered sebum

7. Sebaceous gland ruptures Obstruction bacteria Obstructed sebaceous dilate and rupture.. The altered sebum causes inflammation in the dermis. Altered sebum Sebum causes inflammation

8. Acne Most patients will clear with:Most patients will clear with: AnANTI-INFLAMMATORY ANTIBIOTICAn ANTI-INFLAMMATORY ANTIBIOTIC And aCOMEDOLYTICAnd a COMEDOLYTIC There is no special facial wash – black heads are caused by compressed keratin, not by dirtThere is no special facial wash – black heads are caused by compressed keratin, not by dirt No greasy products on the skin or scalp – these will be smeared on the face and can obstruct the glandsNo greasy products on the skin or scalp – these will be smeared on the face and can obstruct the glands Consider the anti-acne diet but it will interfere with a normal social lifeConsider the anti-acne diet but it will interfere with a normal social life

9. Acne Some antibiotics have anti-inflammatory properties. These include: Tetracycline Vibramycin Minomycin Cotrimoxazole Erythromycin The dose must be adequateThe dose must be adequate

10. Acne COMEDOLYTICS Remove the obstructions in the sebaceous gland There are several compounds: Benzoyl peroxideBenzoyl peroxide Retinoic acidRetinoic acid Azelaeic acidAzelaeic acid AdapaleneAdapalene

11. Acne Other effective therapies are:Other effective therapies are: ANTI-ANDROGENSANTI-ANDROGENS ISOTRETINOINISOTRETINOIN Acne does not respond to such things as zinc capsulesAcne does not respond to such things as zinc capsules

12. Acne Cyproterone acetateCyproterone acetate is an anti-androgen The dose is 50 mg for 10 days a monthThe dose is 50 mg for 10 days a month (days 5 to 14 of the cycle)(days 5 to 14 of the cycle) The pill should to be taken to keep theThe pill should to be taken to keep the cycle regular.cycle regular.

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

14. 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

15. Cystic acne – many scars are left where there were cysts

16. Acne IsotretinoinIsotretinoin is the most effective agent The course is for 5 monthsThe course is for 5 months The dose should be 1 mg per Kg a dayThe dose should be 1 mg per Kg a day The side effects are well toleratedThe side effects are well tolerated

17. Rosacea A common eruption, more common with ageA common eruption, more common with age There is inflammation but no obstruction of sebaceous glandsThere is inflammation but no obstruction of sebaceous glands Papules, pustules, diffuse erythema, and possible induration of the affected areaPapules, pustules, diffuse erythema, and possible induration of the affected area No black headsNo black heads

18. Rosacea Rosacea looks like acne but it is caused byRosacea looks like acne but it is caused by leaking blood vesselsleaking blood vessels Treatment consists of:Treatment consists of: ANTI-INFLAMMATORY ANTIBIOTICSANTI-INFLAMMATORY ANTIBIOTICS in an ADEQUATE DOSE Metronidazole is effectivein an ADEQUATE DOSE Metronidazole is effective Topical antibiotics are not very effectiveTopical antibiotics are not very effective Protection from the sun – UVL aggravates itProtection from the sun – UVL aggravates it

19. Sebaceous gland ruptures Acne – sebum in the skin causes inflammation Rosacea – blood vessels leak

20. Rosacea-like eruption Fluorinated steroids used on the face for long periods cause a rosacea like eruption.Fluorinated steroids used on the face for long periods cause a rosacea like eruption. Only use 1% hydrocortisone on the face for long periods.Only use 1% hydrocortisone on the face for long periods. Treatment –Treatment – ANTI-INFLAMMATORY ANTIBIOTICSANTI-INFLAMMATORY ANTIBIOTICS in an ADEQUATE DOSEin an ADEQUATE DOSE