NEWER WAYS OF ACNE MANAGEMENT

WHAT IS NEW IN
ACNE MANAGEMENT
PRESENTATION
DR KANDARP PANDYA
SCIENCE
IN
ACNE MANAGEMENT
Anti Acne Therapy
Topical Retinoids Tretinoin , Adapalene, Tazorotene
Oral Retinoids Isotretinoin
Topical Antibiotics Clindamycin, Benzoyl Peroxide, Erythromycin
Azelaic acid, Dapsone and Lincomycin
Systemic Antibiotics Tetracyclines, Doxycycline, Minocycline
Erythromycin and Azithromycin
Hormones Norethindrone acetate - Ethinyl estradiol
Norgestimate - Ethinyl estradiol
Spironolactone
Prednisolone/Betamethasone
PROCEDURES MICRODERMABRASION,LASERS &
LIGHTS,CHEMICAL PEELS,
CRYOTHERAPY DERMAROLLERS &
FRACTIONAL LASERS
Acne therapies and their associated
activities
Topical Retinoids:
• Normalize
Desquamation
• Reduce Non –
Inflammatory
and
Inflammatory
lesions
Oral Isotretinoin:
􀁑 Reduces Sebum
􀁑 Normalizes
Desquamation
􀁑 Inhibits P acnes
Growth
􀁑 Reduces
Inflammatory
Response
Antibiotics:
􀁑 Reduce Microorganisms
􀁑 Reduce Inflammatory
Response
Hormones:
􀁑 Reduces Sebum
Production
Goals of Therapy
Depends on whether acne is
􀁑 Non-inflammatory
(comedonal)
􀁑 Inflammatory
(papulopustular)
Topical agents that promote
comedolysis or keratolysis
Examples: tretinoin, adapalene, and
tazarotene)
Powerful antibacterials
examples: benzoyl peroxide,
clindamycin, and combination
therapy
WHAT IS NEW??
IN SCIENCE OF ACNE
MANAGEMENT
• TOPICAL THERAPY
• INTERMITTENT THERAPY FOR
SYSTEMIC MEDICATIONS
• MICRODERMABRASION
• CRYO ROLLER THERAPY
• LASERS & LIGHTS
TOPICAL THERAPY
• TOPICAL
ANTIMICROBIALS
• TOPICAL
RETINOIDS
• TOPICAL
STEROIDS???????
INDIAN ACNE ALLIANCE(IAA)
CONSENSUS GUIDELINES
ACNE IN INDIA
• TOPICAL RETINOIDS ALONG WITH
TOPICAL ANTIMICROBIAL OR BPO HAS
BEEN PORVEN TO REDUCE ACNE (BOTH
COMEDONES AND INFLAMATORY)
FASTER AND TO A GREATER DEGREE
THAN ANTIMICORBIAL THERAPY ALONE
LATEST RECOMMENDATION BY
GLOBAL ALLIANCE FOR ACNE
FOR TOPICAL THERAPY
• TRETINOIN WITH ANTIMICROBIAL OR
BPO IS THE MAINSTAY IN ANY TYPE OF
ACNE MANAGEMENT
Topical Retinoids
• Tretinoin cream, gel, solution, Microsphere gel
– First topical retinoid
– Highly effective but cutaneous irritation
– Various strengths and vehicles available
• Adapalene cream, gel, solution
– Most tolerable of retinoids
– Sensitive skin
– Solution effective for truncal comedonal acne
• Tazarotene cream, gel
– Strongest effect
– Effective for persistent or recalcitrant comedonal acne
– Can be very irritating to skin
Tretinoin: Mechanism of action
Removes the block that clogs the pores
Decreases the level of sebum
Normalizes abnormal follicular cell growth
Promotes detachment of the
Follicular cells (avoids clumping)
• Tretinoin targets Comedo-genesis
– Expulsion of mature comedones
(open & closed type)
– Inhibition of formation & number
of microcomedones.
– Inhibition of inflammatory
reactions
Tretinoin : Powerful Comedolytic
Drawbacks with Conventional
Tretinoin
Side effects
• Effect of drug itself
• Prolong contact of entire dose on skin
• Penetration of drug into skin
Erythema Irritation
Peeling
of skin
Dryness Burning
& itching
The need for microsphere
technology
• First line drug for preventing
hyperproliferation and unplugging
of comedones
• Prevents microcomedone formation
􀁑 Effect of drug itself
􀁑 Prolonged contact of entire dose on skin
􀁑 Effect of solar radiation on drug
TRETINOIN
􀁑 Slow release of drug over 12 hr minimizes
skin irritation
􀁑 Reduces effect of solar radiation on drug
TRETINOIN MICROSPHERE TECHNOLOGY
Associated with:
􀁑 Erythema
􀁑 Irritation
􀁑 Peeling of skin
􀁑 Dryness
􀁑 Burning and
itching sensation
Tretinoin Microsphere Gel
• Available as tretinoin 0.1% & 0.04% gel with
porous microparticles prepared using
biocompatible polymer
• Chemical structure: all-trans-retinoic acid (all-
E)-3,7-dimethyl-9-(2,6,6-trimethyl-1-
cyclohexen-1-yl)-2,4,6,8-nonatetraenoic acid
TRETINOIN
H3C CH3
CH3 CH3
COOH
CH3
Microsphere Technology
Some pores and fracture
lines can be noted on
surface of the microspheres
Porous microspheres can entrap
wide range of active ingredients
Microsphere Technology
• Round porous microspheres particles made
of biocompatible polymer
• Microspheres hold tretinoin in reserve,
allowing skin to absorb small amounts of
tretinoin over time
• The microspheres remain on top of skin and
are easily washed off while bathing or
washing face
Advantages of Microsphere
Technology
• Drug released from microspheres gradually: Patients
experience low levels of skin irritation
• Drug are protected within microspheres: Less likely
to react with UV light from sunrays and therefore
less degradation
• Slow release of drug from microspheres : Reduces
effect of skin peeling due to UV light from sunrays
Aqueous Gel
Microsphere Vehicle
Acne (PSU)
Mechanism : Microsphere
Technology
J of Microencapsulation 1996, Vol.13. No. 5.575-588
Indications and Dosage
• Topical application in the treatment of
acne vulgaris
• It is recommended that gel be applied
once daily in evening after washing face
• Therapeutic results may be noticed after 2
weeks, but up to 7 weeks of therapy may
be required before consistent beneficial
effects are observed
Precautions
• Avoid unprotected exposure to sunlight
• For women: avoid pregnancy during
therapy with tretinoin
MY OBSERVATION
•Don’t apply tretinoin micro sphere gel
on face immediately after washing
face.
• Apply after 10 minutes to prevent
irritation
Adverse Events
• Mild or moderate irritation
• Brief feeling of warmth while applying
• Discomfort or peeling during early weeks of treatment (both
side effects diminish after some days)
• Patients with sensitive skin may experience:
– Excessive redness
– Swelling
– Blisters
– Itching
– Stinging
– Dryness or peeling
ROLE OF TOPICAL STEROIDS
FOR ACNE
• ACNE EXCORI’EE
• FOR RETINOID
DERMATITIS WITH
INFLAMED ACNE
• FOR THIS TYPE OF ACNE
TOPICAL ANTIBACTERIAL
WITH MILD STEROID
COMBINATION PROVE
BETTER ALONG WITH
SYSTEMIC ANTIBIOTIC
INTERMITTENT THERAPY
FOR SYSTEMIC MEDICATION
FOR ACNE MANAGEMENT
WHY WE REQUIRE
INTERMITTENT THERAPY
LONG TERM MEDICATION REQUIRED
PREVENTS OTHER SYSTEMIC SIDE
EFFECTS OF HIGHER DOSES
FOR BETTER PATIENT COMPLIANCE
PREVENTS DRUG INTERACTIONS
􀂄 AVOIDS OVERLAPPING OF DRUGS PASSING
THROUGH SIMILAR METABOLIC CHAIN
ORAL ANTIBIOTIC
AZITHROMYCIN IS THE NEWEST
ANTIBIOTIC FOR ACNE MANAGEMENT
ADVANTAGES OF AZITHROMYCIN ARE
BETTER ABSORPTION, CONVENIENT
DOSING, LESS DRUG RESISTANCE,
AND COST EFFECTIVENESS.
MAIN ADVANTAGE IS INTERMITTANT
DOSING
AZITHROMYCIN
SUNDAY MONDAY
TUESDAY THERAPY
FOR 8 TO 12 WEEKS
500 MG OD FOR 3 DAYS
A WEEK FOR TWO
WEEKS A MONTH FOR
3 TO 6 MONTHS
ORAL ISOTRETINOIN
INDICATION
NODULOCYSTIC ACNE
FULMINANT ACNE
ACNE CORPORIS
DIFFICULT / RECALCITRANT ACNE
MODERATE ACNE IF SCARRING IS
IMMINENT
ACNE ASSOCIATED WITH PSYCHOLOGIC
DISTRESS
HOW IT WORKS
MOST POTENT ANTI ACNE AGENT AVAILABLE
TODAY
POTENT SEBOSUPPRESSIVE
ANTIANDROGENIC THROUGH COMPETITIVE
INHIBITION OF 3 ALPHA HYDROXYSTEROID
OXIDATION BY RETINOL DEHYDROGENASE
RESULTING IN REDUCED FORMATION OF
DIHYDROTESTOSTERONE
NORMALISES DUCTAL HYPERPROLIFERATION
WILL GIVE RETINOL GLOW
ORAL ISOTRETINOIN
AVAILABLE AS 5,10,20, & 40 MG CAP
COPRESCRIBED WITH SYSTEMIC
ANTIBIOTIC FOR SPEEDIER RESULT
ORAL ISOTRETINOIN ADVERSE
EFFECT
CHEILITIS, DRY NOSE, DRY EYES,
ELEVATED TRIGLYCERIDES
HEPATITIS
TERATOGENICITY
DEPRESSION
DIFFERENT REGIMENS
SUGGESTED BY IAA
STANDARD DOSING 0.5 MG TO 1
MG\KG DAILY
INTERMITTANT DOSING 0.5 MG\KG\DAY
FOR 7 DAYS A
MONTH
ESCALATING DOSING 20 MG OD 1 MONTH
THEN RAISE TO
STANDARD DOSE
BELIEVE IT OR NOT
IN EUROPE IT IS
FOUND THAT 90%
OF SUPER MODELS
ARE TAKING
ISOTRETENOIN 10
MG WEEKLY FOR
YEARS
WITHOUT ANY SIDE
EFFECT
SURPRISINGLY
ACNE RATIO IS
VERY MUCH
REDUCED IN THEM
MICRODERMABRASION
IN THIS PROCEDURE
WE ARE REMOVING
UPPERMOST DEAD
STRATUM CORNEUM
OF EPIDERMIS BY
MICRO DERMA
ABRASION
Function of Microdermabrasion
• Stimulation of the epidermal cell
regeneration rate
• Improvement of the micro-circulation of
blood in the skin
• Significant increase in the absorption rate of
topically applied active agents (as a result of
the exfoliation)
INDICATION OF
MICRODERMABRASION
• ACNE SCAR
TREATMENT
• FACIAL GLOW
• EPIDERMAL WRINKLES
• POST ACNE
PIGMENTATION
• ANY TYPE OF
HYPERPIGMENTATION
• COMEDONAL ACNE
LIMITATIONS
• VERY SAFE BUT LIMITATIONS OF
RESULTS
• MANY TIMES TEMPORARY RESULTS
ONLY
ROLE OF MICRODERMABRASSION
FOR ACNE
• COMEDONAL ACNE
• PAPULOPUSTULAR ACNE AFTER STARTING
ANTIBACTARIAL TREATMENT
• AS MAINTENANCE TREATMENT TO
PREVENT RECURRENCE
• ACNE SCARS
CRYOROLLER THERAPY
• NITROGEN GAS IS
CONVERTED TO LIQUID
FORM BY FREEZING
UPTO - 90’C.
• ROLLER DIPPED IN THIS
LIQUID ROLLED OVER
TREATMENT AREA WILL
CAUSE FREEZING AND
WILL REDUCE
INFLAMMATION
HOW IT WORKS
• SUPERFICIAL FREEZING UP TO -5*C OF
AREA WILL LEAD TO REDUCTION IN BLOOD
CIRCULATION IN CAPILLARIES.
• THIS WILL LEAD TO REDUCTION IN
IMFLAMMATION
APPLICATION
• XANTHELASMA PALPEBRARUM
• WARTS
• ALOPECIA AREATA
• KELOID
• HYPERTROPHIC SCAR
• MOLLUSCUM CONTAGIOSUM
• INFLAMED & NODULOCYSTIC ACNE
CRYOROLLER THERAPY
FOR INFLAMED &
NODULOCYSTIC ACNE
• ROLLER
PREPARED FROM
GAUZE OR SS
DIPPED IN TO
LIQUID NITROGEN
CRYOROLLER THERAPY
FOR INFLAMED &
NODULOCYSTIC ACNE
• ROLLER
DIPPED IN TO
LIQUID
NITROGEN AND
SHOULD BE
ROLLED OVER
THE AREA OF
ACNE
CRYOROLLER THERAPY
FOR INFLAMED &
NODULOCYSTIC ACNE
• FREEZING ACNE NODULES
OR CYST REPEATED AT 2
WEEK INTERVAL RESULTS
IN FASTER RESOLUTION
• INFLAMED ACNE CAN
RESOLVE FASTER WITH
WEEKLY CRYOTHERAPY
ALONG WITH OTHER
TREATMENT
• THIS TREATMENT SHOULD
BE COMBINED WITH OTHER
MODALITIES
ADVERSE EFFECTS
• THERE IS INITIAL AGGRAVATION AS
INCREASE IN ERYTHEMA AND
SWELLING, ON ACCOUNT OF
CRYOREACTION.
• CRYOTHERAPY SHOULD BE AVOIDED
IN DARK SKINNED INDIVIDUALS TO
PREVENT POST INFLAMMATORY
DEPIGMENTATION.
• THERE MAY BE BURNS IF EXCESSIVE
FREZZING MAY CAUSE PIH
LASERS & LIGHT FOR ACNE
􀂄 INTENSE PULSE LIGHT
􀂄 BLUE LIGHT THERAPY
􀂄 PHOTODYNAMIC THERAPY
INTENSE PULSE LIGHT
Clinical Indications
􀂄 Hair Reduction (Photoepliation)
􀂄 Acne Clearance
􀂄 Pigmented Lesions (brown spots)
􀂄 Vascular Lesions(spider veins)
􀂄 Rosacea
􀂄 Telangiectasias
􀂄 Psoriasis
􀂄 Photo rejuvenation
The Technology
• Selective
Photothermolysis
• A pre-selected specific
wavelength range of
optical energy is delivered
to the target structures in
a pulse of light.
• The optical energy is
absorbed by the
chromophore (melanin,
hemoglobin, water or
oxyhemoglobin).
Commonly used IPL Settings
for acne treatment
􀂄 POWER 15-20 JOULE
􀂄 MULTIPLE PULSE 3 PULSE IN PULSE
􀂄 PULSE DURATION 10 MS
􀂄 OFF TIME 15 MS
􀂄 FILTER SELECTION MINIMUM WAVE
LENTH IN UR IPL
410/420/430
HOW IPL WORK IN INFLAMED &
NODULOCYSTIC ACNE
􀂄 THREE WAY ACTION
• 410-450 nm will work as antibacterial
for p. acnes
• 585 nm has anti-inflammatory role as
target is oxyhaemoglobin present in
superficial capillaries
• Infrared 850-900 nm will work for
healing of acne lesion
ROLE OF RF WITH IPL
􀂄 NOW NEW IPL ARE
AVAILABLE WITH RF
TECHNOLOGY
􀂄 IT IS BELIEVED THAT RF
ENERGY WILL HEAT UP
AREA TO BE TREATED
WITH IPLWHICH WILL
MAKE A HEAT CURTAIN
􀂄 THIS HEAT CURTAIN WILL
MAKE IPL ENERGY
AVAILABLE TO SPECIFIC
AREA.
􀂄 THIS WILL PREVENT
THERMAL DAMAGE TO
ADJACENT STRUCTURES
AND PROVIDE MAXIMUM
RESULT TO THE
TREATMENT AREA
Acne Lesion Formation
1. Increased sebum production
and hyperkeratinization lead to
blocked hair follicles that create
a closed anaerobic
environment.
2. P. Acnes builds up in this
environment to toxic levels,
damaging the follicle wall and
initiating an inflammatory
response.
3. As part of its reproduction and
metabolism process, P. acne
produces porphyrins.
Acne Clearance
1. When Porphyrin molecules are exposed to
visible light they become chemically active.
2. Porphyrins at the excitation state result in
the formation of singlet oxygen
3. The singlet oxygen combines with cell
membranes to destroy the P. Acnes
How it works…
Photons + porphyrins →excited porphyrin molecules →
cell attacking species →P. acne destruction.
Acne Clearance
There are 2 methods for acne photo therapy clearance:
1. Continuous wave light source
2. Pulsed light source
a. A continuous wave has limited peak power compared to a
pulsed source.
b. Using an intense pulse of 10-30 ms provides 10,000 times
more photons compared with a 10 mw/cm2 continuous
wave source. Consequently the pulsed light source is
much more efficient in activating the porphyrins.
Before and After
Contraindications
􀂄 under 18 years without parental consent pregnancy
􀂄 open lesions
􀂄 epilepsy
􀂄 active Herpes outbreak in the past year
􀂄 melanoma
􀂄 recent sun exposure
􀂄 ISOTRETINOIN therapy
􀂄 photo sensitizing drugs
BLUE LIGHT THERAPY
The Anti inflammatory effect of
405-420 nm blue light - the Shalita experiment
Pro inflammatory
factors (IL
1α;ICAMI)
Keratinocytes
Addition of molecules which
normally stimulate Keratinocytes
in response to adverse external
conditions(INFγ+TNFα)
Keratinocytes
Addition of molecules
which normally
stimulate Keratinocytes
in response to adverse
external conditions
Addition of blue light
Pro inflammatory
factors are
reduced by 80%
STEP 1
Dish
STEP 2
PHOTO DYNAMIC THERAPY
(PDT)
􀂄 AMINOLEVULINIC ACID{ALA} IS
PREFERENTIALLY TAKEN UP BY THE
PILOSEBACEOUS UNITS AND METABOLISED IN
THE HEME SYNTHESIS PATHWAY TO PRODUCE
A BUILDUP OF PROTOPORPHYRIN IX A POTENT
PHOTOSENSITIZER
􀂄 ONCE ACTIVATED BY LIGHT PPIX PRODUCE
SINGLET OXYGEN AND FREE REDICALS THAT
CAUSE DAMAGE TO THE MITOCHONDRIA,
NUCLEI, AND CELL MEMBRANES.
HOW IT WORKS
PROCEDURE
􀂄 ALA (AMINOLEVULINIC ACID) IS
APPLIED TO THE PART TO BE
TREATED AS 20% CREAM BEFORE
1-2 HRS
􀂄 LIGHT SOURCE CAN BE
• RED LIGHT FROM DIODE (635)
• PULSE EXCIMER DYE LASER (634)
• BROADBAND HALOGEN (600-700)
ADVANTAGES OF PDT
• ALA-PDT OFFERS UNIQUE WAY OF
IMPROVING ACNE BY SELECTIVELY
DAMAGING PILOSEBACEOUS UNIT AND
KILLING P.ACNES.
• LITTLE DAMAGE TO SURROUNDING SKIN
• PROMPT AND SUSTAINED IMPROVEMENT
EVEN IN NODULAR AND CYSTIC ACNE
ADVERSE EFFECTS
􀂄 DISCOMFORT DURING TREATMENT
􀂄 TRANSIENT HYPERPIGMENTATION
􀂄 EXFOLIATIVE ERYTHEMA
􀂄 CRUST FORMATION
􀂄 PHOTOSENSITIVITY
NEW PDT APROCH
􀂄 INDOCYANINE DYE (ICG) APPLIED
TOPICALY AND COMBINED WITH
DIODE LASER TO CAUSE
PHOTOTHERMAL DAMAGE TO
SEBACEOUS GLANDS
ART OF ACNE MANAGEMENT
• COMBINATION OF
AVAILABLE
MODALITIES
• APPLICATION OF
NEW MODALITIES
FOR ACNE CONTROL
• REMIX OF OLD
MODALITIES
AVAILABLE
COUNSELLING
• WE ARE TRYING TO CONTROL UR
ACNE TO HAVE BETTER OUTCOME
• NOT COMPLETELY CURING ACNE
Treatment Algorithm
We are moving to the world of
flying car
• WE WILL MODIFY
THE TREATMENT
WITH ADDITION
OF SOME NEW
TREATMENT TO
PRODUCE REMIX
TREATMENT
PROTOCOL
WHAT WE CAN DO
FOR COMEDONAL ACNE
TOPICAL MICROSPHERE
TRETINOIN 0.1% AT
NIGHT
SALICYLIC ACID FACE
WASH WILL DO THE JOB
MICRODERMABRASION
1 SESSION EVERY
MONTH FOR 8 MONTHS
OR
SALICYLIC ACID PEELING
EVERY 15 DAYS FOR 3
MONTHS
FOR PAUOLOPUSTULAR ACNE
• TOPICAL ANTIBACTERIAL
– CLINDAMYCIN IN MORNING
• TOPICAL TRETINOIN
– 0.1% MICROSPHERE TRETINOIN
AT NIGHT
• ORAL AZITHROMYCIN TAB
– 500 MG TAB SMT THERAPY FOR
12 WEEKS
• MICRODERMABRASION
– 1 SESSION EVERY MONTH AFTER
PUSTULES SUBSIDES FOR 8
MONTHS
INFLAMED ACNE
• TOPICAL ANTIBACTERIAL
􀂃 AZITHROMYCIN INTERMITTANT
THERAPY
􀂃 SMT FOR 2 WEEKS A MONTH
• IPL FOR 1 SESSION EVERY 7
DAYS UNTIL INFLAMMATION
SUBSIDES.
– 15 TO 20 JOULE WITH 3 PULSE IN
PULSE WITH 10 MS PULSE & TRT
15 MS
􀂃 MICRODERMABRASION SITTING
AFTER INFLAMMATION
SUBSIDES
􀂃 ONECE A MONTH FOR 8 MONTH
NODULAR & NODULOCYSTIC
ACNE
• AZITHROMYCIN INTERMITTANT THERAPY
– SMT THERAPY FOR 1ST & 2ND WEEK OF MONTH
FOR 6 MONTHS
• ISOTRETINOIN INTERMITTANT THERAPY
– 10 DAYS A MONTH STARTING FROM 3RD WEEK
OF EVERY MONTH FOR 6 MONTHS
• INTENSE PULSE LIGHT IF AVAILABLE
– ONCE A MONTH FOR 6 MONTHS
• CRYOROLLER THERAPY
– WEEKLY
• INTRALESIONAL STEROID
EK IDEA JO BADALDE ISKI DUNIYA
25 YRS OLD GIRL CAME
WITH INFLAMED ACNE
SINCE 3 YRS NOT
RESPONDING TO
CONVENTIONAL
TREATMENT.
RELAPSE AFTER
ISOTRETINOIN COURSE
TAKEN FOR 6 MONTHS.
PATIENT REFUSE TO TAKE
ISOTRETINOIN AGAIN
WHAT I HAVE DONE
• TOPICAL CLINDAMYCIN TWICE A DAY
• AZITHROMYCIN 500 MG SUNDAY MONDAY
TUESDAY COURSE FOR 8 WEEKS
• SESSION OF IPL WITH 430 NM FILTER
– ONE SESSION EVERY WEEK TOTAL 3 SESSION
• MICRODERMABRASION SITTINGS AFTER
INFLAMMATION SUBSIDES
– 1 SESSION EVERY 15 DAYS. -4 SUCH SESSIONS
– THEN MDA 1 SESSION MONTHLY FOR NEXT 4
MONTHS
AFTER 3 MONTHS
NEXT TREATMENT PROTOCOL
• TOPICAL CLINDAMYCIN TWICE A DAY
• TOPICAL TRETINOIN 0.025% FOR 3
HRS AT NIGHT
• AZITHROMYCIN 500 MG TAB SMT ONE
COURSE MONTHLY FOR 3 MONTHS
• MICRODERMABRASION 1 SESSION
EVERY MONTH FOR 3 MONTH
AFTER 6 MONTHS
NOW SHE IS UNDER
MAINTANANCE
TREATMENT.
CLINDAMYCIN
TWICE A DAY
APPLICATION
MICROSPHERE
TRETINOIN 0.1% AT
NIGHT
MATRIMONIAL
PLEASE HELP MR HITESH TO
FIND GOOD LIFE PARTNER
27 YRS OLD PHARMACIST
NODULAR ACNE SINCE 5 YRS
TRIED LOTS OF MEDICATIONS
ISOTRETINOIN 20 MG OD
STOPED AFTER 20 DAYS AS
SGPT RAISED (100)
I TRIED THIS WAY
• TOPICAL APPLICATION HAS NO ROLE
• AZITHROMYCIN 500 MG S M T THERAPY
FOR 1ST & 2ND WEEK OF MONTH FOR 6
MONTHS
• ISOTRETINOIN 20 MG INTERMITTENT
THERAPY FOR 10 DAYS A MONTH
STARTING FROM 3RD WEEK OF MONTH
FOR 6 MONTHS
• IPL TREATMENT ON LAST DAY OF
EVERY MONTH FOR 6 MONTHS
6 MONTHS LATER
NODULOCYSTIC
LESIONS OF FACE
EXCEPT NASAL
REGION REDUCED
REMARKABLY BUT
NASAL AREA STILL
REQUIRES SOME
TREATMENT
CHELITIS WAS THE
ONLY ADVERSE
EFFECT OF
ISOTRETINOIN
REPORTED
NEXT TREATMENT ??
• INTRA LESIONAL STEROID
RESULT OF COMBINATION
TREATMENT
BEFORE AFTER
RESULT OF COMBINATION
TREATMENT
ACNE EXCOR’IEE
HOW WILL I MANAGE??
• AZITHROMYCIN S M T THERAPY FOR 8 WEEKS
• TOPICAL APPLICATION FOR COMBINATION
CREAM FOR FUSIDIC ACID WITH
HYDROCORTISONE FOR 0NE WEEK
• FROM SECOND WEEK TOPICAL CLINDAMYCIN IN
MORNING AND NIGHT APPLICATION OF
MICROSPHRERE TRETINOIN
• MICRODERMABRASION OR SALICYLIC PEEL CAN
HELP FOR FASTER RESULTS
ACNE SCARS WITH NODULAR
ACNE
TREATMENT COMBINATION
• AZITHROMYCIN INTERMITTENT THERAPY
SMT FOR 1ST & 2ND WEEK
• ISOTRETINOIN 20 MG OD INTERMITTENT
THERAPY FOR 10 DAYS A MONTH FOR 6
MONTHS. STARTING 15TH OF EVERY MONTH
• FRACTIONAL ER YAG LASER TREATMENT
FOR 1 SESSION EVERY MONTH FOR 5
MONTHS
• OR
• DERMAROLLER TREATMENT FOR 1
SESSION EVERY MONTH FOR 3 MONTHS
BEAUTIFUL &
HEALTHY SKIN IS GATEWAY OF
YOUR PERSONALITY



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