Dr. Citra Cahyarini, Sp.KK Bagian Ilmu Kesehatan Kulit dan KelaminFK Universitas Yarsi Jakarta

Acne VulgarisDefinition : disorder of the pilosebaceous unit there is a large number of keratin mass that expands to fill the lumen & forms the solid plug in ductus pilosebaceous

Clinical finding : there is comedones, papules, pustules, nodules, cysts

Etiology :GeneticEndocrinePsychisFood / dietSeasonalCosmeticsInjuryetc.

Acne VulgarisPatophysiology :Patients with acne have # An increased sebum production# Abnormal keratinization# Microoragisms colonization# Inflammation

PubertyAndrogen hormone kSebumProductions kKeratinForming kP. Acnes >>(Lipase)Free Fatty AcidSolid Plug inDuctusPilosebaceous

Androgen HormonSebaceous Gland

ClassificationBy Kligman & Plewig, 1975 - Comedonal acne-Papulo-pustules acne- Conglobata acne

By Gruper, 1977- True Acne :w Acne Vulgaris :w Tropical acnew Mechanical acnew Fulminan acnew Neonatal acne

AV Closed ComedonesAV Opened Comedones

Papulo-pustulous AcnesConglobata Acnes

Acne ExcorieeNeonatal/ Infantil Acnes

Acne Vulgaris- True Acne :w Acne Venenata :w Cosmetical acnew Chlor acnew Occupational acnew Acne Physical :w Senile acnew Radiation acne- Acneiform Eruption Acne like

Cosmetic AcneOccupational Acne

Diagnosis BaseAnamnesis Medical Historyw Age, education, occupancy w Cosmeticalw Phsycically depressed w Menstruationsw Climate / season w Injuryw Diet / foods w Drugs

Physical Examination w Oily skin w Comedonal & non comedonalw Another lesions

Differential Diagnoses

w Acneiform eruptionw Sebaceaous adenomaw Rosaceaw Molluscum contagiosumw Perioral dermatitisw Verucca plana

Acneiform Eruption- Initially by inflamation (papulo pustulosa)- Absence of comedones- Usually caused by drugs- Suddenly onset- Affected to wide area- Doesnt match to acne location

Acneiform Eruption Causative drugs :w IodinewVitamin B12w Bromidew Phenobarbitalw INHwTetracyclinew Corticosteroids

Drug induced acne Acneiform Eruption

Acne Rosacea

A chronic skin disease3-4th decade of lifeEtiology is unknownFactors stimulate :Hot beveragesAlcoholUltraviolet light exposureEmotional factors

Stages of evolutionStage 1Persistent erythema with telangiectasesStage 2Persistent erythema, telangiectases, papules, tiny pustulesStage 3persistent deep erythema, dense telangiectases, papules, pustules, nodulesRhinophyma

Perioral dermatitisAcneiform skin eruptionWomen aged 20-40Etiology unknown, used mid or high potency topical steroids

TherapyGoals :To decrease sebum productionTo eliminate keratin plugTo decrease microorganisms populationsTo eliminate inflammationMethods :Skin careTherapy

Systemic Therapy Tetracyline & its derivates Erythromycin Clindamycin LinchomycinAntibiotics Anti androgen Esterogen CorticosteroidIsotretinoin ( 13- cis retinoic acid)Combination TherapySpecial TreatmentsTopical & Systemic Comedo Extraction Tramnicolone acetonide intra lesion Dermabaration

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