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ACNE and related coditions (L70 - Acne (L70.0 - Acne vulgaris, L70.1 -…
ACNE and related coditions
Acne vulgaris/обыкновенное
L70
infl. of the pilosebaceous unit (PSU) >> comedones
↑ prolif. and of corneocytes
↑ concentration Propionibacterium/Cutibacterium acnes (G+, an, secretes porhyrins and lipases >> free fatty acids FFA >> inflam/) in sebum + ↑a TLR2
↑ IL1,8 and TNF-a (TLR2 pathway)
↑ androgens (DHT and testosterone) >> ↑ sebum (R on basal layer of gland) + dehydroepiandrosterone sulfate (DHEA-S) from adrenal gland
фолликул увеличивается, PSU разрывается, яркий восполительный процесс
Treatment
:
5% benzoyl peroxide
(sebostatic, comedolytic - break down the keratin, and bactericidal, prevents neutrophils from releasing reactive oxygenspecies //1 in 500 people experience Hyp and 1/3 phototoxicity to UVB, safe for use in pregnant)
retinoids (tretinoin, adapalene, tazarotene)
azelaic and salicylic acid (antibacterial action)
2-4% clindamycin, sodium sulfacetamide/sulfur
dapsone
oral antibiotic, isotretinoin (for acne that has not responded to other treatments), oral contraceptive pill, spironolactone (antiandrogenic activity for woman); blue light
Acne conglobata/шаровидные
L70.1
nodulocystic acne
Acne excoriee
L70.5
Mainly seen in young women with emotional or psychological disorders who repeatedly pick at lesions
Acne with underlying endocrinologic abnormality
Polycystic ovarian syndrome (PCOS): (5-10%, hirsutism, irregular menses, ± polycystic ovaries, ± obesity, insulin resistance, ↑ LH/FSH ratio, ↓ fertility, ↑ testosterone, acne on jawline),treatment: oral contraceptive pill, spironolactone
Late congenital adrenal hyperplasia
L70 - Acne
L70.0 - Acne vulgaris
L70.1 - Acne conglobata
L70.2 - Acne varioliformis
L70.3 - Acne tropica
L70.4 - Infantile acne
L70.5 - Acné excoriée
L70.8 - Other acne
L70.9 - Acne, unspecified