Acne and Rosacea

Dr. D. Czarnecki MD MBBS

 Acne

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.

Acne patients who change their diets improve.

Starvation will clear acne.

 Acne

Androgens cause the sebaceous glands to enlarge

and produce sebum. Acne occurs at puberty.

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 serum

Stress causes the adrenal glands to release more

androgens and these aggravate acne.
 Acne

Insulin causes the sebaceous glands to enlarge

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 contents of the ruptured gland cause

inflammation
 Sebum on the skin
protects the skin

Androgens
Sebum

Cells produce
Sebaceous gland
Sebum

Sebaceous glands enlarge and produce sebum at puberty.

Androgens are the main hormones influencing sebaceous gland
metabolism.
Insulin also has an important effect
 Abnormal keratinization

Altered sebum bacteria

Sebaceous gland

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.
 Obstruction

Sebum causes
inflammation

Altered sebum bacteria

Sebaceous gland
ruptures

Obstructed sebaceous dilate and rupture..

The altered sebum causes inflammation in the dermis.
 Acne
Most patients will clear with:

An ANTI-INFLAMMATORY ANTIBIOTIC
And a COMEDOLYTIC

There 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 glands
Consider the anti-acne diet but it will interfere with a
normal social life
 Acne
Some antibiotics have anti-inflammatory properties.
These include:
Tetracycline
Vibramycin
Minomycin
Cotrimoxazole
Erythromycin

The dose must be adequate

 Acne

COMEDOLYTICS

Remove the obstructions in the sebaceous gland

There are several compounds:

Benzoyl peroxide
Retinoic acid
Azelaeic acid
Adapalene
 Acne

Other effective therapies are:

ANTI-ANDROGENS

ISOTRETINOIN

Acne does not respond to such things as zinc

capsules
 Acne

Cyproterone acetate is an anti-androgen

The dose is 50 mg for 10 days a month

(days 5 to 14 of the cycle)

The pill should to be taken to keep the

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

Cystic acne many scars are left where there were cysts
 Acne

Isotretinoin is the most effective agent

The course is for 5 months

The dose should be 1 mg per Kg a day

The side effects are well tolerated

 Rosacea
A common eruption,
more common with age
There is inflammation
but no obstruction of
sebaceous glands
Papules, pustules,
diffuse erythema, and
possible induration of
the affected area
No black heads
 Rosacea
Rosacea looks like acne but it is caused by
leaking blood vessels

Treatment consists of:

ANTI-INFLAMMATORY ANTIBIOTICS
in an ADEQUATE DOSE Metronidazole is effective

Topical antibiotics are not very effective

Protection from the sun UVL aggravates it

 Acne sebum in the skin
causes inflammation

Sebaceous gland ruptures

Rosacea blood vessels leak

 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.

Treatment

ANTI-INFLAMMATORY ANTIBIOTICS
in an ADEQUATE DOSE