ACNE VULGARIS

Jullio Ericks M Krey

Residen Pembimbing :
dr. Welly Wijayanti

SPV :
dr. Widya Widita,Sp.KK,M.KES
DEFINITION
Acne is a chronic inflammatory disease of the
pilosebaceous units. It is characterized by
seborrhea, the formation of open and closed
comedones, erythematous papules and pustules.
And in more severe cases nodules, deep pustules
and pseudocysts. In many cases a degree of
scarring will occur.
A. Close Comedones B. Open comedones

C. inflammated Papules  D. Nodule

EPIDEMIOLOGY
The condition usually start in adolescence and frequently resolves by
the mid-twenties.
 Boys : 16th - 19th years old (56 %)
 Girls : 14th – 16th years old (45 %)
 On the other hand for late-onset (age over 24 yo) is
about 8% occur of mature acne.
ETIOLOGY
The exact cause of the AV until now, yet not really clear. But there are
some risk factors indentified from outside (exogenous) and also from
inside (endogenous).
 Genetic factors
 Hormone factors
 Food (diet)
 Cosmetics using factors
 Infection and traumatic factors
 Jobs factors
PATHOGENESIS
The pathogenesis of acne is multifaceted, but there are four basic
steps that have been identified. Each of these processes are
interrelated and under hormonal and immune influence.

 Follicular Hyperkeratinization,
 Excess Sebum Production,
 The Presence and Activity of Propionibacterium Acnes.
 Inflammation.
PATHOGENESIS
Acne pathogenesis

A B C D

Microcomedone Comedone Inflammatory Nodule

papule/pustule
• Hyperkeratotic • Accumulation of • Further expansion of • Rupture of follicular
infundibulum shed fillicular unit wall
• Shedding of keratinocytes and • Proliferation of • Marked perifollicular
keratinocyte sebum P.acnes inflammation
• Sebum • Dilation of • Perifollicular • Scarring
secretion follicular ostium inflammation
CLASSIFICATION

 Plewig and kligman

 Acne Papule/Pustule
 Lehmann classification

Classification based on American Academy of Dermatology

 PLEWIG & KLIGMAN

Grade I : < 10 comedones on 1 side of the face

Grade II : 10-25 comedones on 1 side of the face
Grade III : 25-50 comedones on 1 side of the face
Grade IV : > 50 comedones on 1 side of the face

Note: lesion are comedone

ACNE PAPULE/PUSTULE

Grade I : < 10 lesions papulo/pustulers

Grade II : 10-20 lesions papulo/pustulers
Grade III : 20-30 lesions papulo/pustulers
Grade IV : > 30 lesions papulo/pustulers

Classification based on American Academy of Dermatology

CLASSIFICATION

Lehmann classification

classification comedone Papule/Pustule Nodule/cyst

Mild < 20 < 15 (-)

Moderate 20-100 10- 30 (-)

Severe < 100 > 50 >5

DIAGNOSE
 Patient History (Anamnesa)
 Physical Exam
 Lab. test

DIFFERENTIAL DIAGNOSIS
 Bacterial folliculitis
 Rosasea
 Dermatitis Perioral
 DIFFERENTIAL DIAGNOSIS

 Papules

 Pustules

 Erythematous

 Hair in the middle

 No comedos
bacterial folliculitis
 DIFFERENTIAL DIAGNOSIS

 Erythema

 Telangiectasia

 Edema

 Papules

 Pustules

 No comedos
Rosasea
 DIFFERENTIAL DIAGNOSIS

 primarily affects the mouth or nose

 Small red papules and pustules.

 Mild burning or itching sensation

 No comedos

Perioral Dermatitis
TREATMENT
A. Topical therapy
 Topical peeling substance
 Vitamin A acids (0.025 - 0.1%)
 Benzoyl peroxide (2.5 - 10%)
 Azeleic acid (15 - 20%)
 Salicylic acid (2 - 5%)
 Antibiotic topical:
 oxytetracycline (1%),
 erythromysis (1%),
 clindamycin phosphate (1%)
 Dapsone acid (5%)
 Topical corticosteroid:
 Hydrocortisone 1 - 2,5%,
 intralesional injection of
triamcinolone acetonide 10 mg / cc
for nodulo-cystic lesions
TREATMENT
B. Oral Systemic

 Antibiotic systemic :
o Doxycycline 50-100 mg/day
o Tetracycline 250 mg – 1,0 g/day
o Erythromycin 250 mg 4x/day
o Azithromycin 250 mg 3x/week

 Vitamin A as anti-keratinization (50,000 ui - 150,000 ui / day).

 Isotretinoin (0.5 to 1 mg / kg / day) to inhibit sebum production in

nodulocystic and conglobeate acne
TREATMENT
Mild Moderate Severe
drugs of choice
Comendone Papule/ Papule/ Nodules Conglobata/
Pustule Pustule fulminans

Retinoid topical + Antibiotic oral + Antibiotic oral + Isotretinoin oral ±

First choice 1st Retinoid topical antimicroba topical retinoid topical ± BPO Retinoid topikal ± corticosteroid oral
BPO

Dapsone topical / Dapsone topical / azelaic Antibiotic oral + Isotretinoin oral or Antibiotic oral high
Second choice 2nd azelaic acid / salicylic acid / salicylic acid retinoid topical ± BPO antibiotic oral + dosed + retinoid
acid retinoid topical ± topical + BPO
BPO/ azelaic acid
PREVENTION

 Low Fat diets and Low carbohydrates
 Regular skin care (facial)
Avoid the increase in the number of
sebum lipids and changes in sebum
contents for example with low-fat diets
and carbohydrates and perform skin
care to clean the skin surface

 get enough rest

Avoid the risk factors of acne
such as a lot of cosmetic use,
oily food, stress, drinking alcohol,
 Stress control
and lack of rest
CONCLUSIONS
 AV is a chronic inflammatory disease of the pilosebaceous units. It is
characterized by seborrhea, the formation of open and closed comedones,
erythematous papules and pustules. And in more severe cases nodules/cyst

 Etiology : still not clear yet.

 Risk factors : Genetics, hormonal, food factors, cosmetics, infection, and

occupational factors

 Pathogenesis : follicular hyperkeratinization, excess sebum production, the

presence and activity of propionibacterium acnes and inflammation.

 Skin lesion : polymorphic lesion such as comedo, pustule, papule nodule (cyst), or
scars

 Diagnosed : patient history taking, physical examination, and lab.test

 Treatment : teraphy topical and antibiotic sistemic.

REFERENCE
 Fitzpatrick's Dermatology in General Medicine. 8th ed: Mc Graw Hill
Medical; 2012.
 Burns T, Breathnach S, Cox N, Griffiths C. Rook's Textbook of
Dermatology: Wiley-Blackwell; 2010.
 Djuanda A, Hamzah M, Aisah S. 2017. Ilmu Penyakit Kulit dan
Kelamin Edisi VII. Jakarta: Fakultas Kedokteran Universitas Indonesia.
 Zaenglein et al, 2016, Guidelines of care for the management of
acne vulgaris, J Am Acad Dermatol.
 Khanna Neena, Kubba Raj. 2013, vol 1 edition 1. World Clinic
Dermatology. Jaypee Brothers Medical Publishers (P) Ltd.
 James WD, Berger TG, Elston DM. 2011. Andrew’s Diseases of the Skin
Clinical Dermatology. 11th ed. Elsevier Publishing.
Thank you