Ance Overview

Oct 3, 2012Download as ppt, pdf

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The document provides an overview of acne pathology, treatment options, and the effects of isotretinoin (Roaccutane) including its mechanisms, precautions, and adverse effects. It highlights factors contributing to acne, treatment methods such as topical and systemic therapies, and emphasizes the importance of emotional support and managing antibiotic resistance. Additionally, it notes the complexities of acne treatment and the need for concurrent therapies.

ACNE Overview

Dr Paul Spano
Cosmetic Physician

ACNE Pathology

• Chronic Inflammation - Pilosebaceous Unit
• Abnormal Keratinizaton in Hair Follicle
• Increased Follicular Epithelial Turnover
• High Sebum Production
• Follicle Blockage = Comedone
– Non-Inflammatory
• Propionibacterium acnes
– Chemical Inflammation

General Factors
• Diet - Unconfirmed • Endocrine
• Cosmetics • Androgens
• PCOS
• Oil
• Pre-menstrual Flare
• Irritation
• Summer • Drugs
• Steroids
• UV light
• OCP
• Salt water
• Stress • Occupation
• Sweating
• Common Association
• Oils
• Picking

Aims of Treatment

• Unblocking the Comedones
• Reducing Sebaceous Gland activity
• Reducing Bacterial Count
• Reducing Inflammation
• Cosmesis Short Term - Pimples
• Cosmesis Long Term - Scarring

Treatment
• TOPICAL • SYSTEMIC
– Keratolytics – Antibiotics
• Salicylic Acid • Antibacterial
• Azealic Acid • Antiinflammatory
– Retinoids • Resistance
• Tretinoin • Side Effects
• Adapalene • eg Minocycline
(Dizziness, Ataxia,
– Anti-Bacterial Pigmentation,
• Benzoyl peroxide Headache)
• Topical Antibiotics – Hormones
• Cyproterone
– Spironolactone
• Antiandrogen

Roaccutane

• 4-6 months oral therapy
• 20% need second course
• Teratogenic
• Side Effects ++++++++
• Linked to Teenage Suicide via Depression
and Psychoses

Vitamin A

• Group of compounds
• Cellular differentiaion, organ development
and pigment production (retina)
• Immune function, Antiinflammatory
• all Trans Retinoic acid (Tretinoin)

Roaccutane - M.O.A.

• Inhibits Vit. A metabolism in skin
• Vit A levels increase by 50% in Epidermis
• Sebosuppressive
• 90% red. In gland size, proliferation
• Inhibits Keratinocyte numbers
• Less follicle blockage
• increased water loss - barrier loss
• Inhibits Bacterial Growth
• Antiinflammatory

Roaccutane - Precautions
• Contraindicated
• Pregnancy and Lactation
• Severe Hepatic or Renal Failure
• Relative Contraindications
• Hyperlipideamia
• Diabetes
• Severe Osteoporosis
• Co-medication
• Vit A - Incresed Toxicity
• Tetracyclines - Cranial Hypertension
• Regular Aspirin/NSAIDS - Mucosal damage

Roaccutane - Adverse Effects
Dose Dependent, Reversible
• Cheilitis 80%
• Itching 25%
• Facial Dermatitis 40%
• Skin Fragility 20%
• Xerosis (Dry Skin) • Waxing, Shaving
40% • Abrasive therapy
• Photosensitivity 100% • Desquamation 15%
• Dry Mucosa 40% • Hair Loss 15%
• Conjunctivitis 30% • Retinoid Dermatitis
• Epistaxis 25% • Depression / Psychosis
• I.B.D.
• Flare / Scarring ++

Roaccutane - Adverse Effects 2

• Eyes and Pseudotumour cerebri
• Dryness / Contact Lenses
• Corneal opacities, Cataract
• Pseud. C. with Tetracycline
• Lipids and Liver
• Hypertriglyceridaemia, Hypercholesterolaemia
• Reduced HDL, Hepatic enzyme disruption
• Arthralgia / Myalgia 5%
• Young Adults, can be severe
• +/- Ligament calcification

Roaccutane Adverse Effects 3
• Long Term Toxicity - Bone
• Vitamin A intoxication
• > 2 yrs treatment
• hyperostosis, periostosis, demineralization
• premature epiphyseal closure
• Irreversible
• Teratogenicity
• OPC 1 month before and 3 months after
• Pregnancy Testing
• Monitoring
• LFT , ESR, Glucose, Lipids

Roaccutane cont.

• Links to Teenage Suicide
• Jick Study by Roche to dispel concerns
• Poorly designed
• Raised more concerns
• Depression 20% incidence
• ? Roaccutaanes role

Modern Treatments

• Microdermabrasion
• Crystal Abrasion
• Suction / Oxygenation
• Home exfoliation / AHA / BHA
• Chemical Peels
• Keratolytic
• Exfoliants

Remember…….

• Emotional Support
• Complex Disease
• Concurrent Multiple Treatments
• Antibiotic Resistance
• Roaccutane not a Panacea

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Ance Overview

1. ACNE Overview Dr Paul Spano Cosmetic Physician

2. ACNE Pathology • Chronic Inflammation - Pilosebaceous Unit • Abnormal Keratinizaton in Hair Follicle • Increased Follicular Epithelial Turnover • High Sebum Production • Follicle Blockage = Comedone – Non-Inflammatory • Propionibacterium acnes – Chemical Inflammation

3. General Factors • Diet - Unconfirmed • Endocrine • Cosmetics • Androgens • PCOS • Oil • Pre-menstrual Flare • Irritation • Summer • Drugs • Steroids • UV light • OCP • Salt water • Stress • Occupation • Sweating • Common Association • Oils • Picking

4. Aims of Treatment • Unblocking the Comedones • Reducing Sebaceous Gland activity • Reducing Bacterial Count • Reducing Inflammation • Cosmesis Short Term - Pimples • Cosmesis Long Term - Scarring

5. Treatment • TOPICAL • SYSTEMIC – Keratolytics – Antibiotics • Salicylic Acid • Antibacterial • Azealic Acid • Antiinflammatory – Retinoids • Resistance • Tretinoin • Side Effects • Adapalene • eg Minocycline (Dizziness, Ataxia, – Anti-Bacterial Pigmentation, • Benzoyl peroxide Headache) • Topical Antibiotics – Hormones • Cyproterone – Spironolactone • Antiandrogen

6. Roaccutane • 4-6 months oral therapy • 20% need second course • Teratogenic • Side Effects ++++++++ • Linked to Teenage Suicide via Depression and Psychoses

7. Vitamin A • Group of compounds • Cellular differentiaion, organ development and pigment production (retina) • Immune function, Antiinflammatory • all Trans Retinoic acid (Tretinoin)

8. Roaccutane - M.O.A. • Inhibits Vit. A metabolism in skin • Vit A levels increase by 50% in Epidermis • Sebosuppressive • 90% red. In gland size, proliferation • Inhibits Keratinocyte numbers • Less follicle blockage • increased water loss - barrier loss • Inhibits Bacterial Growth • Antiinflammatory

9. Roaccutane - Precautions • Contraindicated • Pregnancy and Lactation • Severe Hepatic or Renal Failure • Relative Contraindications • Hyperlipideamia • Diabetes • Severe Osteoporosis • Co-medication • Vit A - Incresed Toxicity • Tetracyclines - Cranial Hypertension • Regular Aspirin/NSAIDS - Mucosal damage

10. Roaccutane - Adverse Effects Dose Dependent, Reversible • Cheilitis 80% • Itching 25% • Facial Dermatitis 40% • Skin Fragility 20% • Xerosis (Dry Skin) • Waxing, Shaving 40% • Abrasive therapy • Photosensitivity 100% • Desquamation 15% • Dry Mucosa 40% • Hair Loss 15% • Conjunctivitis 30% • Retinoid Dermatitis • Epistaxis 25% • Depression / Psychosis • I.B.D. • Flare / Scarring ++

11. Roaccutane - Adverse Effects 2 • Eyes and Pseudotumour cerebri • Dryness / Contact Lenses • Corneal opacities, Cataract • Pseud. C. with Tetracycline • Lipids and Liver • Hypertriglyceridaemia, Hypercholesterolaemia • Reduced HDL, Hepatic enzyme disruption • Arthralgia / Myalgia 5% • Young Adults, can be severe • +/- Ligament calcification

12. Roaccutane Adverse Effects 3 • Long Term Toxicity - Bone • Vitamin A intoxication • > 2 yrs treatment • hyperostosis, periostosis, demineralization • premature epiphyseal closure • Irreversible • Teratogenicity • OPC 1 month before and 3 months after • Pregnancy Testing • Monitoring • LFT , ESR, Glucose, Lipids

13. Roaccutane cont. • Links to Teenage Suicide • Jick Study by Roche to dispel concerns • Poorly designed • Raised more concerns • Depression 20% incidence • ? Roaccutaanes role

16. Modern Treatments • Microdermabrasion • Crystal Abrasion • Suction / Oxygenation • Home exfoliation / AHA / BHA • Chemical Peels • Keratolytic • Exfoliants

17. Remember……. • Emotional Support • Complex Disease • Concurrent Multiple Treatments • Antibiotic Resistance • Roaccutane not a Panacea

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Ance Overview

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