ACNE VULGARIS. DR.Anahita Diniyaryan Pharm.D

Transcription

1 ACNE VULGARIS DR.Anahita Diniyaryan Pharm.D

2 آکنه یک بیماری خوش خیم و غیر مهاجم است که اثرات منفی آن بر روی سیستم روانی فرد مورد توجه می باشد. اضطراب کاهش اعتماد به نفس افسردگی

3 درسال 2001 بر اساس آمار 2 بیلیون دالر داروی نسخه ای وبیش از دو برابرفرآورده ی غیر نسخه ای برای درمان آکنه هزینه شده است.

4 EPIDEMIOLOGY Post-adolescent acne predominantly affects women, in contrast to adolescent acne, which has a male predominance. In one survey of over 1000 adults, self-reported acne in men and women was documented as follows 20 to 29 years: 43 and 51 percent, respectively 30 to 39 years: 20 and 35 percent, respectively 40 to 49 years: 12 and 26 percent, respectively ages 50 and older: 7 and 15 percent, respectively

5 مراحل بوجود آمدن آکنه

6 Inflammation results from the proliferation of P. acnes Enzymes produced by P. acnes may promote the degradation of the follicular wall and follicular rupture. P. acnes surface proteins may play a role in antigenicity, triggering humoral and cell-mediated immune responses. Heat shock proteins, which promote inflammation via the innate immune system, are produced by P. acnes. Porphyrins produced by P. acnes may contribute to adjacent tissue damage and inflammation

7 TREATMENT PRINCIPLES Determining the most effective course of treatment for acne involves a comprehensive assessment of the patient. Treatment of acne is aimed at counteracting follicular hyperproliferation, increased sebum production, Propionibacterium acnes proliferation, and inflammation

8 انواع آکنه

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13 جایگاه مصرف فرآورده های غیر نسخه ای در افراد با آکنه ی خفیف تا متوسط سه ماه اول درمان ادامه ی مصرف در صورت بهبود

14 و 5 مواد موثر در ترکیبات غیر نسخه ای سالیسیلیک اسید) 0.5 تا %2( روغن درخت چای %5 آلفا هیدروکسی اسید سولفور) 2.5 تا %5( بنزوییل پراکساید) %10( آزالییک اسید %20

15 مواد احتماال موثر در ترکیبات غیر نسخه ای محصوالتی که ترشح سبوم را کنترل می کنند اپی لوب سبوزم گلوکونات روی Vit PP

16 مواد احتماال موثر در ترکیبات غیر نسخه ای محصوالتی که کیفیت سبوم را تغییر می دهندو مانع تجمع آن در الیه درم می شوند Fluidactiv

17 مواد احتماال موثر در ترکیبات غیر نسخه ای محصوالتی که جلوی رشد باکتری را می گیرند مشتقات روی کلروهگزیدین THYMOL

18 مواد احتماال موثردرفرآورده های غیر نسخه ای محصوالتی که روند التهابی را کنترل می کنند فیتواسفنگوزین انوکسولون inflamine THYMOL

19 مواد احتماال موثردرفرآورده های غیر نسخه ای

20 محصوالت درمانی پوست چرب Nordihydroguaiaretic acid (NDGA)

21 URIAGE HYSEAC AHA and BHA complex Licorice extract Piroctone Olamine Mattifying agent

22 چند محصول پر مصرف جهت درمان انواع آکنه Acknyl thymol

23 NOREVA Zeniac Roll Active Mandelic acid 5% Soluble sulfur 0.5% Salicylic Acid 2%

24 BIODERMA SEBIUM GLOBAL ضدالتهاب و الیه بردارمخصوص انواع آکنه حاوی: ENOXOLONE (جلوگیری از تولید سیتوکین های پیش التهابی( AHA ester 6% Citric acid 5% Salicylic acid 2% (الیه بردار( ZINC GLUCONATE )از تکثیر P.acne جلوگیری کرده وترشح سبوم را کنترل می کند(

25 NOREVA ACTIPUR Keratozine A 5% Phytosphingosine PP Vitamin Micro-sponges

26 دارودرمانی آکنه

27 PRETREATMENT ASSESSMENT Clinical type and severity of acne (eg, comedonal, papulopustular, mixed, nodular) Determines the types of treatments needed Skin type (eg, dry, oily) Influences choice of topical drug vehicle Presence of acne scarring Indicates need to consider more aggressive acne therapy and treatments for scarring Presence of postinflammatory hyperpigmentation Indicates need to consider therapies for hyperpigmentation as well as the need to resolve and prevent inflammatory acne lesions Menstrual cycle history and history of signs of hyperandrogenism in women Identifies need to consider laboratory workup and hormonal therapies women with acne vulgaris") Treatment history Identifies successful and unsuccessful previous treatments History of acne-promoting cosmetic products and medications Identifies potential for improvement with discontinuation of topical cosmetic products Psychological impact of acne on the patient Identifies need for a more aggressive treatment approach or psychological services

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29 ATTENTION ترتینویین و بنزوییل پراکساید همزمان بر روی پوست استفاده نشود

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33 جلوگیری از ایجاد مقاومت باکتریایی Only prescribe antibiotics when necessary. The duration of treatment should be limited; an oral antibiotic should be discontinued when there is no additional clinical improvement or clinical improvement is absent.one panel of experts suggested limiting treatment courses to a maximum of 12 to 18 weeks when feasible In order to avoid changing oral antibiotics prematurely, six to eight weeks of therapy should be allowed prior to evaluating treatment efficacy.after six to eight weeks, a change in the type of antibiotic can be considered if there is no response. In cases in which a partial response is seen, therapy should be continued and response reassessed after another six to eight weeks. If oral antibiotics are stopped and need to be restarted, prescribe the same antibiotic the second time as long as it remains effective Do not simultaneously treat with a topical antibiotic and an oral antibiotic, particularly if the agents are chemically different. Avoid use of antibiotics (topical or oral) as monotherapy or as maintenance therapy Prescribe benzoyl peroxide at the start of antibiotic therapy. Concomitant use of benzoyl peroxide can decrease the incidence of antibiotic resistance. It may also be helpful to use benzoyl peroxide for a minimum of five to seven days between antibiotic courses. Prescribe a topical retinoid. A topical retinoid should be used at the start of treatment with an oral antibiotic.combination therapy with a retinoid and oral antibiotic improved treatment efficacy in several studies, including two randomized trials. Topical retinoids are effective as long-term maintenance therapy and can decrease dependence on the extended use of antibiotics

34 ADJUNCTIVE THERAPIES Microdermabrasion Office-based superficial chemical peels Comedo extraction Intralesional glucocorticoids( mg/ml) Heat Diet :Data on favorable effects of dietary factors such as zinc, omega-3 fatty acids, antioxidants, vitamin A, and dietary fiber on acne vulgaris are limited.further studies are necessary to determine the roles of these supplements in acne vulgaris. IGP (INSULIN LIKE GROWTH FACTOR) OR GLYCEMYC LOAD STRESS smoking

35 Oral isotretinoin Scarring acne Acne causing significant psychological distress Acne fulminans Antibiotic-induced gram-negative folliculitis in patients with acne vulgaris

36 Administration subsequently increased to 1 mg/kg/day. Dosing can be once or twice daily. The total treatment goal is 120 to 150 mg/day, and is typically reached over four to six months (usual duration of treatment 20 weeks)the drug is discontinued without tapering. There is some evidence that lower doses may also be effective. Absorption of isotretinoin is improved when taken with food (especially high-fat meals); thus, administration during meals is recommended Other acne medications are typically discontinued during isotretinoin therapy. Isotretinoin causes temporary xerosis, cutaneous atrophy, and skin fragility.and topical acne medications may be poorly tolerated. Isotretinoin should not be given with tetracycline antibiotics due to the risk of idiopathic intracranial hypertension (pseudotumor cerebri) associated with both of these drugs. Acne may initially worsen with isotretinoin therapy; initiating therapy at 0.5 mg/kg/day during the first month may decrease this risk. The early flare typically resolves with further treatment.more severe flares may occur in patients presenting with severe inflammatory acne (eg, acne conglobata, acne fulminans). In some of these cases, the inflammatory nodules may ulcerate or form exuberant granulation tissue. If this happens, isotretinoin is temporarily stopped. Systemic glucocorticoids (0.5 to 1 mg/kg/day) are sometimes given before isotretinoin therapy or concurrently for the first two to four weeks of treatment in an attempt to prevent severe flares. Rarely, isotretinoin may induce acne fulminans.

37 Isotretinoin and pregnancy Isotretinoin is teratogenic. Women of childbearing potential must use two forms of contraception during treatment and for one month thereafter.

38 درمان آکنه در بارداری

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40 درمان آکنه در نوزادان

41 Infantile acne Infantile acne is a distinct entity from neonatal cephalic pustulosis. It presents at three to four months of age. It results from hyperplasia of sebaceous glands secondary to androgenic stimulation, and is more common in boys.the clinical presentation is more severe than that of cephalic pustulosis and consists of typical acneiform lesions including comedones, inflammatory papules, pustules, and sometimes nodules on the face.it usually clears spontaneously by late in the first year of life, but may persist until three years of age.

42 Infantile acne Treatment may be required, because infantile acne can persist and occasionally cause scarring, unlike neonatal cephalic pustulosis. When inflammation is mild or moderate, mild keratolytic agents, such as benzoyl peroxide (2.5%), topical antibiotics (eg, erythromycin or clindamycin), or topical retinoids may be used.in more severe cases, systemic therapy with oral erythromycin or oral isotretinoin may be indicated.

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