ACNE VULGARIS

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