Acne vulgaris is a common skin condition characterized by comedones, papules, pustules, nodules and/or cysts caused by obstruction and inflammation of hair follicles. The most common triggers are puberty and hormonal changes, while key factors in pathogenesis are follicular keratinization, androgens, and Propionibacterium acnes. Diagnosis involves assessing severity and psychosocial impact, while treatment options range from topical creams for mild cases to oral isotretinoin for severe cases. Perioral dermatitis is a facial rash around the mouth often caused by overuse of topical steroids. It is treated by discontinuing steroids and using oral antibiotics

1. Acne vulgaris
Nino Lortkipanidze

2. Acne Vulgaris
Acne vulgaris is the formation
of comedones, papules,
pustules, nodules and/or cysts
as a result of obstruction and
inflammation of pilosebaceus
units (hair follicles and their
accompanying sebaceus gland)

3. Etiology
The most common trigger is puberty
Other triggers include hormonal changes
that occur with pregnancy or throughout the
menstrual cycle; occlusive cosmetics,
cleansing agents, humidity and sweating
Acne may improve in summer months
because of sunlight anti-inflammatory effects

4. Pathogenesis
Key factors are follicular keratinization, androgens
and Propionibacterium acnes

5. Symptoms and Signs
Comedones appear as whiteheads (closed
comedones) or blackheads (open comedones).
Whiteheads are flesh-colored or whitish
paplable lesions 1 to 3 mm in diameter.
Blackheads are similar in appearance but with a
dark center
Papules and pustules are red lesions 2 to 5 mm
in diameter
Nodules are larger, deeper and more solid than
papules
Cysts are suppurative nodules

6. Symptoms and Signs

7. Acne conglobata
Acne conglobata is the most
severe form of acne vulgaris,
affecting men more than
women
Patients have abscesses,
fistulated comedones,
keloidal and atrophic scars
The back and the chest are
severely involved. The arms,
abdomen, buttocks and even
the scalp may be affected

8. Acne Fulminans
• Rare form of extremely severe cystic acne
• Teenage boys, chest and back
• Rapid degeneration of nodules leaving ulceration
• Fever, leukocytosis, arthralgias are common
• Tx; oral steroids, isotretinoin

9. Diagnosis
Assessment for contributing factors (eg,
hormonal, mechanical or drug-related)
Determination of severity (mild, moderate,
severe)
Assessment of psychosocial impact

10. Differential diagnosis
• Rosacea
• Corticosteroid-induced acne
• Perioral dermatitis
• Acneform drug eruption
Rosacea
Corticosteroid-induced acne Perioral dermatitis Acneform drug eruption

11. Treatment
Comedones: Topical tretinoin
Mild inflammatory acne: Topical antibiotics,
benzoyl peroxide or both
Moderate acne: Oral antibiotics
Severe acne: Oral isotretinoin
Cystic acne: Intralesional triamcinolone

12. Perioral dermatitis
A facial rash that tends to occur around the mouth
Most often it is red and slightly scaly or bumpy
Any itching or burning is mild
It may spread up around the nose, and occasionally
the eyes while avoiding the skin adjacent to the lips
It is more rare in men and children

13. Couse
• One of the most common factors is prolonged
use of topical steroid creams and inhaled
prescription steroid sprays used in the nose and
the mouth
• Overuse of heavy face creams and moisturizers
are another common cause
• Other causes include skin irritations, fluorinated
toothpastes, and rosacea.

14. Diagnosis
Diagnosis is by appearance
Perioral dermatitis is distinguished from acne by
the absence of comedones and from rosacea by
the latter’s lack of lesions around the mouth and
eyes
Seborrhoeic dermatitis and contact dermatitis
must be excluded
Biopsy, which is generally not clinically necessary,
shows spongiosis and a lymphohistiocytic
infiltrate affecting vellus hair follicles

15. Treatment
• first step in treating perioral dermatitis is to
discontinue all topical steroid creams and
fluorinated dental products
• Once the steroid cream is discontinued, the
rash appears and feels worse for days to
weeks before it starts to improve
• Heavy face creams should also be stopped

16. Treatment
The most reliably effective treatment is oral
antibiotics. These are taken in decreasing doses for
three to twelve weeks
Topical antibacterial creams and lotions may also be
used for faster relief. These can be continued for
several months in order to prevent recurrences
Isotretinoin has been successfully used to treat
granulomatous perioral dermatitis
Even after successful treatment, perioral dermatitis
sometimes comes back later. Usually, the same type
treatment will again be effective. Many cases that
come back eventually turn into rosacea

17. Rosacea
• Chronic inflammatory eruption
of the flush areas of the face
• Erythema, papules, pustules,
teleangectasia, hypertrophy of
the sebaceous glands
• Usually mid-face
• Often women ages 30-50

18. Ocular Rosacea
• Blepharitis, conjunctivitis
• Keratitis, iritis, episcleritis
• C/o gritty, stinging sensation
• occurs in about 58% of
rosacea patients

19. Chronically inflamed eyelid margins
may be confused with seborrheic
dermatitis
•

20. Etiology
Vasomotor liability
Hot liquids, ETOH, steroids (oral and topical)
ie: perioral dermatitis
Demodex folliculorum not causative

21. Differential Diagnosis
 Acne Vulgaris
 Lupus erythematosus
 Bromoderma, ioderma
 Papular syphilid

22. Inflammatory
rosacea
• Papules and pustules
are characteristic
Granulomatous
Rosacea
• Midface, perioral, lateral mandible
areas
• Noncaseating granulomas

23. Rhinophyma
• Men over 40
• Pilosebaceous
gland hyperplasia
with fibrosis,
inflammation,
and
telangiectasia
• Treatment is
surgery

24. Rosacea Treatment
• Long-term oral tetracycline is suppressive,
required for ocular rosacea
• Topical metronidazole
• Sunscreens, avoidance of flushing triggers
• Flash lamped pumped dye laser for
telangectasias