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18th October 2012 - Acne

The acne disease pathway

Androgen hormone

influences and stimulates

sebaceous gland

Excessive sebum production

Hyperkeratinization

Sebaceous glands enlarge

Over production of epithelial cells lining

follicles

Microcomedone formation

A thick hyperkeratotic plug

White heads and black heads form

Inflammation and immune response

Propionibacterium acnes colonization in

anaerobic environment

Formation of pustules and cysts

Scars

Pathogenic factors of acne

1.Excessive sebum production

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

Pathogenic factors of acne

1.Excessive sebum production

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

1

2

3

4

Actions of Anti-Acne TherapiesActions of Anti-Acne TherapiesTopical retinoidsand naphthoic acidderivatives: Normalize desquamation

Reduce inflammatory response

Antibiotics: Kills microorganisms Reduce inflammatory

response

Hormones: Reduce sebum

production

Benzoylperoxide: Kills

microorganisms Keratolytic

Oral Isotretinoin: Reduces sebum Normalizes

desquamation Inhibits P acnes Reduces inflammatory

response

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 ReferWhen to Refer

Criteria for referral • Severe nodulo-cystic acne (refer immediately)• Risk/evidence of scarring and post-

inflammatory 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 Websitewww.acneacademy.org