1. Back to Medical School 18 th October 2012 - Acne

2. The acne disease pathway Androgen hormone influences and stimulates sebaceous gland Excessive sebum production Hyperkeratinization Sebaceous glands enlarge Over production of epithelial cells lining follicles Microcomedone formation A thick hyperkeratotic plug Microcomedone formation A thick hyperkeratotic plug White heads and black heads form Inflammation and immune response Propionibacterium acnes colonization in anaerobic environment Formation of pustules and cysts Scars Pathogenic factors of acne 1.Excessive sebum production 2.Hyperkeratinization (abnormal cell turnover) 3.Inflammation and immune response 4.P. acnes colonization Goal of treatment: To target as many pathogenic factors of acne as possible Pathogenic factors of acne 1.Excessive sebum production 2.Hyperkeratinization (abnormal cell turnover) 3.Inflammation and immune response 4.P. acnes colonization Goal of treatment: To target as many pathogenic factors of acne as possible 1 1 2 3 3 4 4

3. Actions of Anti-Acne Therapies Topical retinoids and naphthoic acid derivatives: Normalize desquamation Reduce inflammatory response Antibiotics: Kills microorganisms Reduce inflammatory response Hormones: Reduce sebum production Benzoyl peroxide: Kills microorganisms Keratolytic Oral Isotretinoin: Reduces sebum Normalizes desquamation Inhibits P acnes Reduces inflammatory response

4. Skin care for acne patients No need to overdose on cleansing! Soap free cleansing/soap substitute washes Use non-comedogenic cleansers, make up and moisturisers (oil free) Avoid greasy products Educate re squeezing and associated scarring

5. When to Refer Criteria for referral Severe nodulo-cystic acne (refer immediately) Risk/evidence of scarring and post- inflammatory hyperpigmentation (PIH) Moderate acne that has failed to respond to 2 or more courses of treatments Mild to moderate acne in patients who have extreme psychological distress Galderma Nurse Team

6. Acne Academy Website www.acneacademy.org