Management of Acne – 5Management of Acne – 5 where do we stand ? where do we stand ?

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Treatment challengesTreatment challenges

• Acne venenataAcne venenata

• Nodulocystic acneNodulocystic acne

• Acne fulminansAcne fulminans

• Acne conglobataAcne conglobata

• Predominant closed comedonesPredominant closed comedones

• Nodular lesionNodular lesion

• Cysts of acneCysts of acne

• Preventing Early Acne ScarsPreventing Early Acne Scars

• Dermaplaning (before peeling)Dermaplaning (before peeling)

• Chemical PeelsChemical Peels

• Intense Pulsed Light (IPL)Intense Pulsed Light (IPL)

• Skin LiftingSkin Lifting

Feature ChallengesFeature Challenges

• Life style -( look concern )Life style -( look concern )

• Acne Venenata (cosmetics, environmental)Acne Venenata (cosmetics, environmental)

• Drug resistanceDrug resistance

How can one class of drugs have such a wide How can one class of drugs have such a wide range of seemingly unrelated activities?range of seemingly unrelated activities?

The clinical spectrum of retinoidsThe clinical spectrum of retinoids

Retinoids availableRetinoids available

• TretinoinTretinoin

• AdapaleneAdapalene

• TazaroteneTazarotene

• Alitretinoin Alitretinoin

• Bexarotene Bexarotene

Topical Agents available for AcneTopical Agents available for Acne

• TretinoinTretinoin

• AdapaleneAdapalene

• TazaroteneTazarotene

• IsotretinoinIsotretinoin

• MotretinideMotretinide

• RetinaldehydeRetinaldehyde

• Retinoyl –beta glucuronideRetinoyl –beta glucuronide

Topical retinoids in AcneTopical retinoids in AcneTopical Retinoids Have Multiple Anti-Acne ActionsTopical Retinoids Have Multiple Anti-Acne Actions

– Inhibit the formation and reduce the number of microcomedo Inhibit the formation and reduce the number of microcomedo

– Reduce mature comedonesReduce mature comedones

– Reduce inflammatory lesionsReduce inflammatory lesions

– Promote normal desquamation of follicular epitheliumPromote normal desquamation of follicular epithelium

– Anti-inflammatory actionAnti-inflammatory action

– Likely to enhance penetration of other drugsLikely to enhance penetration of other drugs

– Likely to maintain remission of acne by inhibiting Likely to maintain remission of acne by inhibiting

microcomedo formation, thus preventing new lesionsmicrocomedo formation, thus preventing new lesions

““In dermatology, retinoids are the In dermatology, retinoids are the most exciting most exciting andand important important

pharmacological agents in light of their large presence on the pharmacological agents in light of their large presence on the therapeutic scene. If no more retinoids were added to the therapeutic scene. If no more retinoids were added to the inventory, clinicians would still be busy for decades, searching inventory, clinicians would still be busy for decades, searching for a new therapeutic applications in diverse areas of clinical for a new therapeutic applications in diverse areas of clinical medicine”medicine”

- Dr. Albert M. Kligman, - Dr. Albert M. Kligman, PhiladelphiaPhiladelphia

August August 19981998

IntroductionIntroduction• It is a common inflammatory condition of It is a common inflammatory condition of

pilosebaceous unitpilosebaceous unit• 90% of adolescent suffer from it during their life time90% of adolescent suffer from it during their life time• Cause is multifactorial- abnormal keratinization, Cause is multifactorial- abnormal keratinization,

P.acnes, genetics, hormones, environmentP.acnes, genetics, hormones, environment• It produces wide variants acne It produces wide variants acne • Many topical and oral medications are effective, but Many topical and oral medications are effective, but

selection of appropriate medication /procedure is selection of appropriate medication /procedure is effectiveeffective

Management of AcneManagement of Acne

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