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Clinicopathologic correlation of acne lessions
Closed Comedone• The follicular infundibulum is
distended, filled with keratin and sebum, and the follicular epithelium is attenuated
• The follicular ostium is narrow
Clinicopathologic correlation of acne lessions
Open Comedone• Resembles the closed
comedone with the exception of a patulous follicular ostium
Clinicopathologic correlation of acne lessions
Inflammatory papule• Acute and chronic inflammatory
cells surround and infiltrate the follicle, which shows infundibular hyperkeratosis
Clinicopathologic correlation of acne lessions
Nodule• The follicle is filled with acute inflammatory cells
• With the rupture of the distended follicle, there is a foreign body granulomatous response
A. Lower face: comedones, papules, pustules and scars
A. The cheek: large, open comedones and inflammatory papules and pustules that become confluent
A. Papules and nodules on the forehead and cheeks with little scarring apparent
B. Nodular acne with scars on the cheekC. Large nodules on the cheek and chin with
significant scarring
A. Large, confluent nodules with interconnecting channels, with atrophic and hyperplastic scars
B. Extensive nodules on the chest and arms with severe scarring
C. Nodules, crusted, ulcers, and scars on the shoulder
D. Severe nodular acne of the back with little residual uninvolves skin
Akne Komedonal dibagi:
• Tingkat I : < 10 komedo pada 1 sisi• Tingkat II : 10-25 komedo pada 1 sisi• Tingkat III : 25-50 komedo pada 1 sisi• Tingkat IV : >50 komedo pada 1 sisi
GRADE III; papulopustules
Akne Tipe PapulopustularLesi terdiri atas campuran komedo dan
lesi yang beradang, terdiri atas pustula atau papula:
• tingkat I: < 10 lesi beradang pada 1 sisi
• tingkat II: 10-20 lesi beradang pada 1 sisi
• tingkat III: 20-30 lesi beradang pada 1 sisi
• tingkat IV: >30 lesi beradang pada 1 sisi
Punched-out and ice pick scars on the
cheek
Extensive atrophic
scarring of the back
Severe hypertrophic
scarring of the back
Acne Vulgaris, Scarring
Refractory to treatment: check compliance• Exlude gram-negative folliculitis• Female: exclude polycystic ovary syndrome, adrenal or ovarian
tumors, congental adrenal hyperplasia• Males: exclude congenital adrenal hyperplasiaMaintenance: topical retinoid + Benzoyl peroxyde
TREATMENT
TREATMENT
Refractory to treatment: check compliance
• Exlude gram-negative folliculitis• Female: exclude polycystic ovary
syndrome, adrenal or ovarian tumors, congental adrenal hyperplasia
• Males: exclude congenital adrenal hyperplasia
Maintenance: topical retinoid + Benzoyl peroxyde
Acneiform Eruptions
• Steroid Folliculitis• Drug-Induced Acne• Epidermal Growth Factor Receptor Inhibitor-
Assoiated Eruption• Occupatinal Acne and Chloracne• Gram-Negative Folliculitis• Radiation Acne• Tropical Acne• Acne Aestivalis
Steroid Folliculitis• After administration of systemic
glucocorticoid, a folliculitis may appear• Mainly on the trunk, shoulders, and upper
arms, with lesser involvement of the face• Tx: -stop corticosteroid
-topical retinoids-topical antibiotics sometimes
Epidermal Growth Factor Receptor (EGFR) Inhibitor-Assoiated
Eruption• EGFR inhibitor primarily used to treat non-small cell lung cancer, colorectal cancer, and breast cancer.
• Ex: gefitinib, cetuximab, erlotinib
Occupatinal Acne and Chloracne• Coal tar derivatives, insoluble cutting oils, and chlorinated hydrocarbons
• Ocupational acne characterized by papules, pustules, large nodules and true cysts
• The lesions are not restricted to the face and more common on covered areas with intimate contact to clothing saturated with the offending compound
• Chloracne means occupational acne caused from chlorinated hydrocarbons
• Tx: topical or oral retinoids and oral antibiotics
Gram-Negative Folliculitis
• May occur in patient with pre-existing acne treated with long-term oral antibiotics, especially tetracyclines
• May appear concentrated around the nose or as deep-seated nodules
• Tx: - Appropriate antimicrobial agent- Recalcitrant cases, improves with oral isotretinoin for 4-5 months- Some cases, oral cephalosporin may be given for 2 weeks combine with isotretinoin
Radiation Acne
• Ionizing radiation and UV radiation may induce acnefrom eruption
• Excessive exposure to UV radiation may produce a yellow, athropic plaque studded with large, open comedones. Known as Favre-Racouchot syndrome
• The lesions: usually symmetrically distributes on the temporal and periorbital areas.
• tx: oral or topical retinoids as well as extraction
Tropical Acne
• Tropical climates• Occurs mainly on the trunk and buttocks• The lesions: deep, large, inflammatory nodues
with multiple draining areas, resembling acne conglobatas
• Tx: - Systemic antibiotics- Removing the patient to a cooler environment
Acne Aestivalis
• A monomorphous eruption, consist of multiple, uniform, red, papular lesions seen after sun exposure
• Almost all cases have occured in women, 20-30 y.o.
• The lesions are common on the shoulders, arms, neck, and chest
Bambang SuhariyatoLAB/SMF KESEHATAN KULIT DAN KELAMIN
FK UJ/ RSD Dr. SOEBANDI JEMBER
TUMOR / BEDAH KULIT
• Classify the hair disorder based on pathogenetic principles and clinical pattern.
• Exclude or confirm the most common hair growth disorders based on pattern and diagnostic tools.
• Dispel misconceptions and educate the patient.• Treat as appropriate for the confirmed or suspected
diagnosis.• Provide emotional support for patients who are
adversely affected by the cosmetic effects.
Excess hair
• Hirsuitisme : hair growth in woman under androgen controls : moustache, beard, chest etc.
• Hypertrichosis : refer to hair density or length for particular age, race and sex. Maybe generalized or localized.
Laser (1)• Light Amplification by Stimulated Emission of
Radiation• Cara kerja : berkembang ke selektif
fototermolisis• Selektif fototermolisis: terapi untuk lesi
vaskular, pigmentasi, tattoo, folikel rambut tanpa menyebabkan kerusakan jaringan non target
• Variabel : lama denyutan, fluence dan panjang gelombang. ( kromofor ).
Absorpsi cahaya oleh kromofor kulit sesuai
dengan panjang gelombang.
Kromofor: • molekul yang menyerap
cahaya dengan panjang gelombang tertentu
• kromofor utama pada kulit: – oksihemoglobin, air, dan
melanin
Laser (2)
• EBM terbaik : kel. pigmentasi congenital, tato, hair removal ,kelainan vaskular (terutama : PWS), tumor jinak kulit, rejuvenating (fractional)
• RESIKO penggunaan laser: eye injury, efek samping (pigmentasi, jaringan parut)
Infantile port-wine stain (A) before and (B) after four treatments with a 595 nm, 1.5-msec pulsed dye laser. (Reprinted with permission Arch Derm 2000; 136:942.)
Segmental ulcerating hemangioma. (A) No response to systemic corticosteroids. (B) A response occurs after treatment with alfa interferon and pulsed dye laser.
Spot Test
Fluence 6,5 J/cm2 Wavelength 1064 nm Spotsize 3 mm Rep Rate 10 Hz
Q-switched Nd:YAG laser
Before After Spot Test