Acne and RosaceaDr. D. Czarnecki MD MBBS

AcneIt 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.

AcneAndrogens 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.

AcneInsulin 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

AndrogensSebaceous glandSebum on the skin protects the skinSebumSebaceous glands enlarge and produce sebum at puberty.Androgens are the main hormones influencing sebaceous gland metabolism. Insulin also has an important effectCells produce Sebum

Sebaceous glandAbnormal keratinizationbacteriaAbnormal 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.Altered sebum

Sebaceous gland rupturesObstructionbacteriaObstructed sebaceous dilate and rupture.. The altered sebum causes inflammation in the dermis.Altered sebumSebum causes inflammation

AcneMost patients will clear with:

An ANTI-INFLAMMATORY ANTIBIOTICAnd a COMEDOLYTIC

There is no special facial wash black heads are caused by compressed keratin, not by dirtNo greasy products on the skin or scalp these will be smeared on the face and can obstruct the glandsConsider the anti-acne diet but it will interfere with a normal social life

AcneSome antibiotics have anti-inflammatory properties. These include:TetracyclineVibramycinMinomycinCotrimoxazoleErythromycin

The dose must be adequate

AcneCOMEDOLYTICS

Remove the obstructions in the sebaceous glandThere are several compounds:

Benzoyl peroxideRetinoic acidAzelaeic acidAdapalene

AcneOther effective therapies are:

ANTI-ANDROGENS

ISOTRETINOIN

Acne does not respond to such things as zinc capsules

AcneCyproterone 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 scarsisotretinoin is the most effective drug for cystic acne

Cystic acne many scars are left where there were cysts

AcneIsotretinoin 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

RosaceaA common eruption, more common with ageThere is inflammation but no obstruction of sebaceous glandsPapules, pustules, diffuse erythema, and possible induration of the affected areaNo black heads

RosaceaRosacea looks like acne but it is caused byleaking blood vessels

Treatment consists of:

ANTI-INFLAMMATORY ANTIBIOTICSin an ADEQUATE DOSE Metronidazole is effective

Topical antibiotics are not very effective

Protection from the sun UVL aggravates it

Sebaceous gland rupturesAcne sebum in the skin causes inflammationRosacea blood vessels leak

Rosacea-like eruptionFluorinated 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 ANTIBIOTICSin an ADEQUATE DOSE