DISCUSSION ACNE VULGARIS
A.
Definition of Agne Vulgaris
Acne vulgaris is
a skin disease caused by chronic inflammation of the follicular polisebasea
characterized by blackheads, papules, pustules, and cysts on peridilection
(face, shoulders, upper portion of superior extract, chest, and back).
Acne Vulgaris is a
chronic inflammatory disease of the pilosebasea unit with keratin accumulation
and blockage of the sebaceous glands. The disease is characterized by
blackheads, papules, pustules, nodules and cysts in certain predilection sites
such as the face, neck, chest, upper back and upper arms.
B.
Etiology
Acne vulgaris is
caused by a blockage of sebum in the skin polysebacea glands. The formation of
sebum includes the following factors:
1.
External factors
a.
Cosmetics
The ingredients
that often cause acne are present in various facial creams such as talcum
powder, moisturizers, sunscreen creams and night cream containing ingredients
such as lanolin, petrrolatum, vegetable oils, and pure chemicals.
b.
Food
High-fat diets and
carbohydrates will cause acne.
c.
Bacteria
Microbes involved
in the formation of acne are corynebactrium acne, staphylococcus epidermis and
pityrosporum ovale. Of the three most important microbes are C. acne, which
works indirectly.
d.
Chemical material
Several kinds of
chemicals can cause eruptions similar to acne such as yulida, corticosteroids,
I.N.H, anti-conforts, tetracyclines, and Vit. B12.
e.
Climate
Winter can affect
the recurrence of acne whereas in the acne areas the temperature arises when
the temperature is hot and low.
2.
Internal factors
a.
Hormone
1)
Androgen
This hormone
plays an important role because the palm glands are very sensitive to this
hormone. The anrogen hormone is derived from the testes and adrenals that cause
large-scale palm glands and increased sebum production.
2)
Estrogen
In physiology,
estrogen is not affected by sebum production. Estrogens can lower levels of
gonadotropin derived from the pituitary gland that has the effect of lowering
sebum production
3)
Progesterone
In the amount of
physiology, has no effect on the activity of fat glands. permanent sebum
production during the menstrual cycle, but sometimes progesterone can cause
premenstrual acne
4)
Psychic
In some people
stress and emotional disturbance can cause acne exacerbations. The exact
mechanism on this is unknown. Anxiety causes the patient to manipulate the
aknenya mechanically, resulting in damage to the follicle wall and new lesions
arise. Another theory says that exacerbations are caused by increased production
of androgen hormones from the adrenal glands and sebum, even the fatty acids in
the sebum increases.
5)
Age
Most of these
cases are present in many ages women
14-17 years old, male 16-19 years old.
6)
Family
Through genes in
the elderly (father, mother or both) have a history of acne vulgaris may be
passed on to his son
C.
Classification of Agne Vulgaris
Acne vulgaris is
classified by its verification:
1.
Tropical Ance
Great acne
vulgaris in hot and humid climates, characterized by large nodules, cysts, and
pustules that cause conglobata abscesses and scar tissue and tend to be limited
to the back, neck, buttocks, thighs and upper arms.
2.
Acne Fulminan
The severe acne
rare form that affects teenage boys is characterized by the growth of nodules
and plaques that are highly inflamed and suppurative degeneration that leaves
ulceration, fever, weight loss, anemia, leukocytosis, elevated blood
sedimentation rates and polyarthitis.
3.
Pioderma Fasiale
Pioderma is a skin
disease caused by staphylococus and streptococcus or both.
4.
Acne Mechanics
The accumulation of
acne lesions present by mechanical factors damaging the skin form, including
scrubbing, rubbing, stretching, pressure, retraction, and withdrawal, can be
triggered by factors such as detachable straps, clothing labels, orthopedic
appliances, backpacks, and seat and seat on the bus or car.
Acne vulgaris is classified as komedonal (ie black and white
blackheads) papulopustular (papules and pustules) or cystic
a.
stage I acne has fewer than 10 blackheads,
papules, or pustules on one side of the face.
b.
Stage II acne has 10 to 20 blackheads, papules
or pustules
c.
Acne stage III has 25 – 50
d.
stage IV acne has more than 50
Acne vulgaris is classified according to its mild weight
based on the overall grading by pillsbury and colleagues divided into four
levels
1. Tk I Few / large
blackheads with / without multiple papules
2. Tk II
Blackheads, papel, pustules
3. Tk III
Blackheads, papel, pustules, and nodules
4. TK IV Blackheads,
papel, pustules, nodules, cysts and large scars.
Acne
variants include:
1.
Acne excoriate
Occurs in
individuals who manipulate acne obsessively. Can cause a lot of scarring bn
2.
Akne conglobata
The most severe
form of cystic acne with deep cysts, multifel comedo and real scarring. This
condition can be accompanied by malaise, and fever, may need to be maintained
in the hospital.
3.
Keloidalis Acne
Multiple keloid
scarring in places where there are acne lesions.
D.
Pathophysiology
During childhood,
the sebaceous glands are small and inherently dysfunctional, these glands are
under endocrine control, especially the androgen hormones. In the age of
puberty, androgen hormones stimulate the sebaceous glands and cause the gland
to dilate and secrete a natural oil, the sebum that rises up to the top of the
hair follicles and flows out on the skin surface.
In acne-prone
teenagers, androgen stimulation increases the responsiveness of the sebaceous
glands so that acne occurs when the pilosebaceous duct is blocked by the sebum
pile. This stacked material will form blackheads
E.
Clinical Manifestations
a.
Inflammation: There are typical lesions
(blackheads), papules, pustules, nodules, and cysts on the face, shoulders,
upper chest, upper back, neck, upper arm, and gluteal.
b.
Post-Inflammation: erythema, hyperpigmentation,
keloid as on face, back and chest
F.
Prevention
Acne can be
controlled with sensible therapy that continues until the disease process
disappears spontaneously, aimed at preventing the formation of microkomedo,
through the reduction of follicular hyperkeratosis and sebum production.
Initial control requires at least 4-8 weeks is also important to pay attention
to the heavy emotional impact on acne. The prevention that can be done are:
a.
Wash always face morning and night with a
cleanser containing salicylic-acid to peel away dead skin cells. Or facial skin
scrub at least once a week. Always always absorb oil paper to absorb excess oil
on the face.Use also a mask for oily skin once a week.
b.
To kill acne-causing bacteria, use a face soap
that contains benzoyl-peroxide, or sulfur soap. And use an anti-bacterial /
acne mask once a week. If over-the-counter acne medicines do not work, ask your
dermatologist for acne medications that contain vitamin A derivatives such as
Retin-A.
c.
Low-fat diet.
d.
Enough rest.
e.
Use of cosmetics to taste.
f.
Avoid dust pollution.
g.
Avoid punching.
G.
Complications
a.
Acneoformis eruption
b.
Acne venenata and acne due to physical
stimulation
c.
Rosacea
H.
Diagnostic Examination
a.
Examination of sebum ekskohlease is the
expenditure of sebum plugs with blackhead extractor (spoon unna). Sebum which
clogs the follicle looks as solid mass like wax / mass like soft rice with
black tip sometimes.
b.
Histopathological examination shows a
non-specific picture of a chronic inflammatory cell infusion around the
follicle polisebasea with sebum mass in the follicle. In the inflamed cysts
have disappeared replaced with the connective tissue mass of sebum fluid mixed
with blood, dead tissue, and loose keratin.
c.
Microbiological examination of microorganisms
that have a role in the etiology and pathogenesis of disease.
d.
Examination of the composition and skin surface
lipid levels (free fatty acids) increased.
I.
Management
a.
General advice
1.
Illumination (explanation)
2.
Treatment: facial skin care, scalp and hair care,
cosmetics, diet, emotions and psychosomatic factors
b.
Drugs
1.
Topical medicines
a)
Tretinoin
(vit A acid)
Dosage: 1x daily
at night, in case of erythema and desquamation after 5 days, the drug can be
used 2x a day. Rute of giving: depends on the skin and age of the patient.
b)
Benzoyl
peroxide
Dosage: starting
with a low dose first, then gradually replaced with high doses.Routing route:
In the Pustula
c)
Topical
antibiotics
Dosage:
frequently used antibiotics al: clindamycin: 1%, erythromycin: 2%,
tetracycline: 1 / 2-5% .Route: on the skin
d)
Acidic
acid
e)
alpha
hydroxy acids (AAAH)
f)
Physical
irritant
2.
Oral Medicine
a.
Oral Antibiotics
Oral antibiotics
are used for prolonged periods but their toxicity should be low. This
antibiotic is not used alone but together with a drug that can perform skin peels
among others
1)
Tetracycline
: Dosage: 1 gram / day, given ½ hour before meals
2)
Erythromycin
: Dosage: 1 gram / day
b.
Diamino diphenyl sulphon (DDS)
c.
Hormones
1)
Corticosteroids
Used a solution
with a concentration of 2.5 mg / ml and the injection can be repeated every 1-2
weeks
2)
Anti-pregnancy pill
A relatively large
dose of ecogenic doses is required so that it can produce feminine effects in
men and menstrual disorders in women. This hormone is best administered in the
form of an anti-pregnant pill containing exogenous and progesterone, especially
for pre-menstrual acne
3)
Anti-anrogen testostern
Siproteron acetate
together esterogens are only used in women with acne and severe sebors,
resistant pustular acne and resistant refractory knees.This hormone can be
grazing the palm gland to react to.
d.
Vitamin A
When administered
orally together with oral and tropical antibiotics, Vitamin A is effective for
acne of nodular and cystic forms. Presumably this vitamin affects the
production or metabolism of androgens. The dose is 50.000-100.000 i.u./day.
e.
Isotretinoin
A 13-cis-retinot
acid form is used for the treatment of cystic acne and coglobata. In most cases,
the drug provides the perfect remission for months to years.Dosis: 1mg / kg /
day.
f.
Zinc
Dosage: 3 x 200mg / day
g.
Diuretics
Giving 1 week before menstruation
