Biharis are richer than Marathis

Heads of state | Dermatology | Acne Vulgaris

Acne vulgaris

・ Epidemiology (3)

- 85% of the population affected (!)

- Usually starts in the 11th / 12th Years of life and healing between the ages of 20 and 30


- ♂>♀

Acne vulgaris

・ Etiology (3)

- Polygenic, autosomal dominant inheritance of the predisposing factors (e.g. seborrhea, follicular hyperkeratosis) is suspected

- Growth of sebaceous glands due to androgens during puberty


- Inflammatory reaction is favored by propionibacteria

Acne vulgaris

・ Clinic (5) (picture)

- Infestation of sebum-rich skin regions

- Closed comedones


→ Hemispherical lesion from which whitish contents evacuate when pressed.


- Open comedones


→ With a black center through melanin production


- Inflammatory papules, pustules, nodules, abscesses


- In the course also cysts, fistulas, scars

Acne vulgaris

・ Shapes (6)

- Acne comedonica

- Papulopustular acne


- Acne conglobata


- Acne inversa


- Acne neonatorum ("newborn acne")


- Acne infantum

Acne comedonica

・ Definition (1)

- Open and closed comedones, especially on the face
Papulopustular acne

・ Definition (2)

- Inflammatory papules and pustules arising from comedones

- Severe course with infestation outside the face

Acne conglobata

・ Definition (2) (image)

- Severe seborrhea with fistulous comedones and multiple melting nodules

- Particularly affected back and neck

Acne inversa

・ Definition (3)

- Risk factors: obesity, nicotine abuse, familial accumulation

- Atypical pattern of infestation: Localization not typical of acne, but rather intertriginous occurrence


- characteristic clinic: abscesses, fistula and keloid formation on axillae and groin

Acne neonatorum ("newborn acne")

・ Definition (2)

- manifestation in the first weeks of life

(→ The cause is assumed to be an increased activity of the child's adrenal cortex with a simultaneous increased response of the sebum glands to androgens.)


- Self-limiting without specific treatment

Acne infantum

・ Definition (2) (image)

- manifestation in the 6th-16th centuries Month of life, possibly caused by endocrinological disorders

(→ Further clarification recommended if there are further indications of hyperandrogenemia.)


- Specific treatment indicated to prevent scarring

Acne vulgaris


・ Therapy (2)

- local therapy

- Systemic therapy


Acne vulgaris

・ Local Therapy (4)

- Thorough cleaning

- Keratolysis (azelaic acid benzoyl peroxide)


- Local antibiotics: erythromycin, clindamycin


- Local retinoids: adapalene

Acne vulgaris

・ Systemic Therapy (2)

- Systemic antibiotics: Minocycline, Doxycycline → Indication: Clear inflammatory component

- ♀: Oral contraceptive in combination with antiandrogen (→ sebum production ↓) (example preparation: cyproterone acetate)


- Retinoids: isotretinoin (vitamin A derivative) systemic

- cause a normalization of the cornification through inhibition and modulation of the keratocytes

→ Decreased proliferation of sebum-producing cells

Retinoids

・ Indication (1)

- Moderate and severe acne
Retinoids

・ Contraindication (2)

- pregnancy

- Women of childbearing age without contraception: Strong teratogenic effects even after short-term use


→ Retinoid embryopathy including CNS, cardiovascular, facial and extremity defects

Retinoids

・ Side effects (2)

- Skin and mucous membranes: dry skin, xerostomia, cheilitis, pruritus

- Changes in the blood count: triglycerides ↑, HDL ↓, glucose ↑, liver: AST ↑, ALT ↑