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Back to Medical School 18th October 2012 - Acne The acne disease pathway Androgen hormone influences and stimulates sebaceous gland Sebaceous glands enlarge Over production of epithelial cells lining follicles 1 Excessive sebum production Hyperkeratinization 2 Microcomedone formation A thick hyperkeratotic plug Scars 3 Inflammation and immune response Formation of pustules and cysts Propionibacterium acnes colonization in anaerobic environment Pathogenic factors of acne 1. Excessive sebum production 4 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 White heads and black heads form Actions of Anti-Acne Therapies Topical retinoids and naphthoic acid derivatives: Normalize desquamation Benzoyl peroxide: Kills microorganisms Keratolytic Oral Isotretinoin: Reduce inflammatory response Reduces sebum Normalizes desquamation Inhibits P acnes Reduces inflammatory response Antibiotics: Kills microorganisms Reduce inflammatory response Hormones: Reduce sebum production 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 When to Refer Criteria for referral • Severe nodulo-cystic acne (refer immediately) • Risk/evidence of scarring and postinflammatory 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 Acne Academy Website www.acneacademy.org