introduction to acne and burn with its treatment

1. ACNE AND BURNS
PRESENTED BY: SHIKHA .N.
BARSAINYA(14MPH703)
CLINICAL PHARMACY
INSTITUTE OF PHARMACY, NIRMA
UNIVERSITY.

2. ACNE

3. Define
Acne vulgaris (or simply acne) is a chronic skin condition characterized by areas of
 blackheads
 Whiteheads
 Pimples
 greasy skin
 scarring
It is a skin condition that occurs when your hair follicles become plugged with oil and
dead skin cells.

4.  Acne usually appears on your
 face
 neck
 chest
 back
 shoulders
 The resulting appearance may lead to
 Anxiety
 reduced self-esteem
 depression
 thoughts of suicide.

5. Prevalence
 85% adolescents experience it
 Prevalence of comedones (lesions) in adolescents
approaches 100%
 Acne vulgaris is the most common cutaneous disorder
in the U.S.
 It affects more than 17 million Americans.

6. Types of acne
 Non-inflammatory Acne
 Very mild acne vulgaris
 Includes appearance of whiteheads and blackheads
 Inflammatory Acne
 Moderate form of acne vulgaris
 Includes appearance of papules, pustules, and macules
 Cystic Acne
 Severe form of acne vulgaris
 Includes appearance of cysts and nodules
 Often leads to deep acne scarring

7. Risk factors
 Hormonal changes. Such changes are common in teenagers, women
and girls, and people using certain medications, including those
containing corticosteroids, androgens or lithium.
 Family history. Genetics plays a role in acne. If both parents had acne,
you're likely to develop it, too.
 Greasy or oily substances. You may develop acne where your skin
comes into contact with oily lotions and creams or with grease in a work
area, such as a kitchen with fry vats.
 Friction or pressure on your skin. This can be caused by items such as
telephones, cellphones, helmets, tight collars and backpacks.
 Stress. This doesn't cause acne, but if you have acne already, stress may
make it worse

8. Causes
Four main factors cause acne:
 Oil production
 Dead skin cells
 Clogged pores
 Bacteria
 Acne vulgaris commences in the pilosebaceous units in the dermis.
These units consist of hair follicle and the associated sebaceous glands.
 Acne typically appears on your face, neck, chest, back and shoulders.
These areas of skin have the most oil (sebaceous) glands. Acne occurs
when hair follicles become plugged with oil and dead skin cells.
 Hair follicles are connected to oil glands. These glands secrete an oily
substance (sebum) to lubricate your hair and skin. Sebum normally
travels along the hair shafts and through the openings of the hair
follicles onto the surface of your skin.

9.  When your body produces an excess amount of sebum and dead skin
cells, the two can build up in the hair follicles. They form a soft plug,
creating an environment where bacteria can thrive. If the clogged pore
becomes infected with bacteria, inflammation results.
 The plugged pore may cause the follicle wall to bulge and produce a
whitehead (called as closed comedo i.e. its content do not reach the
surface of the skin).
 Or the plug may be open to the surface and may darken, causing a
blackhead (called as open comedo). A blackhead may look like dirt
stuck in pores. But actually the pore is congested with bacteria and oil,
which turns brown when it's exposed to the air.
 Pimples are raised red spots with a white center that develop when
blocked hair follicles become inflamed or infected. Blockages and
inflammation that develop deep inside hair follicles produce cyst-like
lumps beneath the surface of your skin. Other pores in your skin,
which are the openings of the sweat glands, aren't usually involved in
acne.

10. Sings and symptoms
 Whiteheads (closed plugged pores)
 Blackheads (open plugged pores — the oil turns
brown when it is exposed to air)
 Small red, tender bumps (papules)
 Pimples (pustules), which are papules with pus at their
tips
 Large, solid, painful lumps beneath the surface of the
skin (nodules)
 Painful, pus-filled lumps beneath the surface of the skin
(cystic lesions)

11. Pathogenesis:
Acne vulgaris is a disease of
pilosebaceous follicles.
Factors:
 Retention hyperkeratosis.
 Increased sebum production.
 Propionibacterium acnes
within the follicle.
 Inflammation

12. Initial pathogenesis (reason
unknown):
follicular hyperkeratinization
proliferation +
decreased desquamation of
keratinocytes
hyperkeratotic plug
(microcomedone)

13. Pathogenesis
Sebaceous glands enlarge
Sebum production increases
Growth medium for P. Acnes
plugs provide anaerobic
Lipid-rich environment

14. Pathogenesis
Bacteria thrive
Inflammation results
Chemotactic factors attract neutrophils
Depending on conditions
Non-inflammatory
open/closed comedones
Inflammatory papule/
pustule/nodule

15. Diagnosis
There are multiple scales for grading the severity of acne
vulgaris, three of these being:
 Leeds acne grading technique: Counts and categorizes lesions
into inflammatory and non-inflammatory (ranges from 0–10.0).
 Cook's acne grading scale: Uses photographs to grade severity
from 0 to 8 (0 being the least severe and 8 being the most severe).
 Pillsbury scale: Simply classifies the severity of the acne from 1
(least severe) to 4 (most severe).

16. Treatment
Lifestyle and home remedies:
 Wash problem areas with a gentle cleanser
 Over-the-counter acne products to dry excess oil and promote peeling: eg
product containing benzoyl peroxide as the active ingredient or products
containing sulfur, resorcinol or salicylic acid.
 side effects — such as redness, dryness and scaling — that often improve after the
first month of using them.
 Avoid irritants: avoid oily or greasy cosmetics, sunscreens, hairstyling products
or acne concealers. Use products labeled water-based or noncomedogenic, which
means they are less likely to cause acne.
 Use an oil-free moisturizer with sunscreen. For some people, the sun worsens
acne. And some acne medications make you more susceptible to the sun's rays. use
a nonoily (noncomedogenic) moisturizer that includes a sunscreen.
 Watch what touches your skin. Keep your hair clean and off your face. Also
avoid resting your hands or objects, such as telephone receivers, on your face.
Tight clothing or hats also can pose a problem, especially if you're sweating.
Sweat and oils can contribute to acne.
 Don't pick or squeeze blemishes. Doing so can cause infection or scarring

17. Pharmacological treatment:
Topical medications
 Retinoids
 These come as creams, gels and lotions.
 Retinoid drugs are derived from vitamin A and include tretinoin (Avita,
Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage).
 Apply this medication in the evening, beginning with three times a week,
then daily as your skin becomes used to it.
 It works by preventing plugging of the hair follicles.
 Antibiotics:
 These work by killing excess skin bacteria and reducing redness.
 For the first few months of treatment, you may use both a retinoid and an
antibiotic, with the antibiotic applied in the morning and the retinoid in the
evening.
 The antibiotics are often combined with benzoyl peroxide to reduce the
likelihood of developing antibiotic resistance.
 Examples: clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya)
and erythromycin with benzoyl peroxide (Benzamycin).

18.  Dapsone (Aczone):
 This gel is most effective when combined with a topical retinoid.
 Side effects include redness and dryness.
Oral medications
 Antibiotics:
 For moderate to severe acne
 Oral antibiotics reduce bacteria and fight inflammation.
 Choices for treating acne include tetracyclines, such as minocycline
and doxycycline.
 Usually topical medications and oral antibiotics are used together to
reduce the risk of developing antibiotic resistance. Eg topical benzoyl
peroxide along with oral antibiotics
 Side effects: upset stomach and dizziness
 These drugs also increase your skin's sun sensitivity. They can cause
discoloration of developing permanent teeth and reduced bone growth
in children born to women who took tetracyclines while pregnant.

19.  Combined oral contraceptives:
 Useful in treating acne in women and adolescent girls.
 The Food and Drug Administration approved three products that
combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz).
 Side effects: headache, breast tenderness, nausea, weight gain and
breakthrough bleeding. A serious potential complication is a slightly
increased risk of blood clots.
 Anti-androgen agent:
 The drug spironolactone (Aldactone) may be considered for women and
adolescent girls if oral antibiotics aren't helping.
 It works by blocking the effect of androgen hormones on the sebaceous
glands.
 Side effects: breast tenderness, painful periods and the retention of
potassium.

20.  Isotretinoin:
 This medicine is reserved for people with the most severe acne.
 Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for
people whose acne doesn't respond to other treatments.
 Oral isotretinoin is very effective.
 But because of its potential side effects, closely monitor the tretment.
The most serious potential side effects include ulcerative colitis, an
increased risk of depression and suicide, and severe birth defects.

21. BURNS
A burn is a type of injury to flesh or skin caused by exposure to:
1. excessive heat
2. Chemicals
3. fire/steam
4. radiation
5. electricity

22. Causes of burns
Thermal
exposure to flame or a hot object
Chemical
exposure to acid, alkali or organic substances
Electrical
result from the conversion of electrical energy into heat. Extent
of injury depends on the type of current, the pathway of flow, local
tissue resistance, and duration of contact
Radiation
result from radiant energy being transferred to the body resulting in
production of cellular toxins
22

23. Types of burns
There are three primary types of burns:
 First
 second
 third-degree

24. First-Degree Burn
First-degree burns cause minimal skin damage. They are also called
“superficial burns” because they affect the outermost layer of skin. Signs of a
first-degree burn include:
 redness
 minor inflammation (swelling)
 pain
 dry, peeling skin (occurs as the burn heals)
 Since this burn affects the top layer of skin, the signs and symptoms
disappear once the skin cells shed. First-degree burns usually heal within
three to six days.

25. First-degree burns are mostly treated with home care. Healing time may be
quicker if you treat the burn sooner. To treat this type, you can:
 soak the wound in cool water for five minutes or longer
 take acetaminophen or ibuprofen for pain relief
 apply aloe vera gel or cream to soothe the skin
 use an antibiotic ointment and loose gauze to protect the affected area

26. Second-Degree Burn
 Second-degree burns are more serious because the damage extends
beyond the top layer of skin.
 This type of extensive damage causes the skin to blister and become
extremely red and sore.
 Some blisters pop open, giving the burn a wet appearance.
 Due to the delicate nature of such wounds, frequent bandaging is
required to prevent infection.
 This also helps the burn heal quicker.
 Some second-degree burns take longer than three weeks to heal, but most
heal within two to three weeks.
 In some severe cases, skin grafting is required to fix the subsequent
damage. Skin grafting borrows healthy skin from another area of the
body and replaces it at the site of the burned skin.

27. You can generally treat a mild second-degree burn by:
 running the skin under cool water for 15 minutes or longer
 taking over-the-counter pain medication (acetaminophen or ibuprofen)
 applying antibiotic cream to blisters

28. Third-Degree Burn
 Third-degree burns are the worst burns.
 They cause the most damage, extending through every layer of skin.
 The damage can even reach the bloodstream, major organs, and bones,
which can lead to death.
 There is a misconception that third-degree means most painful. With
this type of burn, the damage is so extensive that you may not feel pain
because your nerves are damaged.
 Depending on the cause, third-degree burns cause the skin to look:
 waxy and white
 charred
 dark brown
 raised and leathery

29.  There is also technically a fourth-degree burn.
 In this type, the damage of third-degree burns extends beyond the
skin into tendons and bones.

30. Pathophysiology
 At temperatures greater than 44 °C (111 °F), proteins begin losing their
three-dimensional shape and start breaking down.
 This results in cell and tissue damage.
 Many of the direct health effects of a burn are secondary to disruption in
the normal functioning of the skin.
 They include disruption of the skin's sensation, ability to prevent water
loss through evaporation, and ability to control body temperature.
 Disruption of cell membranes causes cells to lose potassium to the
spaces outside the cell and to take up water and sodium.
 In large burns (over 30% of the total body surface area), there is a
significant inflammatory response.
 This results in increased leakage of fluid from the capillaries,and
subsequent tissue edema.

31.  This causes overall blood volume loss, with the remaining blood
suffering significant plasma loss, making the blood more
concentrated.
 Poor blood flow to organs such as the kidneys and gastrointestinal
tract may result in renal failure and stomach ulcers.
 Increased levels of catecholamines and cortisol can cause a
hypermetabolic state that can last for years.This is associated with
increased cardiac output, metabolism, a fast heart rate, and poor
immune function.

33. Diagnosis
 Burns can be classified by depth, mechanism of injury, extent, and
associated injuries.
 The most commonly used classification is based on the depth of
injury.
 The depth of a burn is usually determined via examination, although a
biopsy may also be used.
 Size:
 The size of a burn is measured as a percentage of total body surface
area (TBSA) affected by partial thickness or full thickness burns
 Superficial burns are not involved in the calculation

34. There are a number of methods to determine the TBSA like:
 Wallace rule of nines,
 Lund and browder chart
 Lund and Browder Chart is the most accurate because it adjusts for
age
 Rule of nines divides the body – adequate for initial assessment for
adult burns

35. Lund Browder Chart used for determining
BSA
35

36. RULES OF NINES
 Head & Neck = 9%
 Each upper extremity (Arms) = 9%
 Each lower extremity (Legs) = 18%
 Anterior trunk= 18%
 Posterior trunk = 18%
 Genitalia (perineum) = 1%
36

37.  Severity:
American Burn Association severity classification
Minor Moderate Major
Adult <10% TBSA Adult 10–20% TBSA Adult >20% TBSA
Young or old < 5%
TBSA
Young or old 5–10%
TBSA
Young or old >10% TBSA
<2% full thickness burn
2–5% full thickness
burn
>5% full thickness burn
High voltage injury High voltage burn
Possible inhalation
injury
Known inhalation injury
Circumferential burn
Significant burn to face,
joints, hands or feet
Other health problems Associated injuries

38.  The classification is based on a number of factors, including total
body surface area affected, the involvement of specific anatomical
zones, the age of the person, and associated injuries.

39. Treatment
 Resuscitation begins with the assessment and stabilization of the
person's airway, breathing and circulation.
 If inhalation injury is suspected, early intubation may be required.
 This is followed by care of the burn wound itself.
 People with extensive burns may be wrapped in clean sheets until
they arrive at a hospital.
 As burn wounds are prone to infection, a tetanus booster shot
should be given if an individual has not been immunized within
the last five years.

40. Intravenous fluids
 In those with poor tissue perfusion, boluses of isotonic crystalloid solution
should be given.
 In children with more than 10-20% TBSA burns, and adults with more than
15% TBSA burns, formal fluid resuscitation and monitoring should follow
 This should be begun pre-hospital if possible in those with burns greater than
25% TBSA.
 Children require additional maintenance fluid that includes glucose.
 Those with inhalation injuries require more fluid.
 Crystalloid fluids used: lactated Ringer's ,normal saline, glucose.
 Crystalloid fluids appear just as good as colloid fluids (albumin and fresh
frozen plasma), and as colloids are more expensive they are not recommended.
 Blood transfusions are rarely required.
 They are typically only recommended when the hemoglobin level falls below
60-80 g/L (6-8 g/dL) due to the associated risk of complications.
 Intravenous catheters may be placed through burned skin if needed or
intraosseous infusions may be used.

41. Wound care
 Early cooling (within 30 minutes of the burn) reduces burn depth and pain,
but care must be taken as over-cooling can result in hypothermia.
 It should be performed with cool water 10–25 °C (50.0–77.0 °F) and not
ice water as the latter can cause further injury.
 Chemical burns may require extensive irrigation.
 Cleaning with soap and water, removal of dead tissue, and application of
dressings are important aspects of wound care.
 If intact blisters are present, it is not clear what should be done with them.
Some tentative evidence supports leaving them intact. Second-degree
burns should be re-evaluated after two days.
 First-degree burns can be manage without dressings.
 Topical antibiotics are often recommended.
 Silver sulfadiazine (a type of antibiotic) is not recommended as it
potentially prolongs healing time. There is insufficient evidence to support
the use of dressings containing silver or negative-pressure wound therapy.

42. Medications
Pain management:
 simple analgesics (such as ibuprofen and acetaminophen) and opioids
such as morphine.
 Benzodiazepines may be used in addition to analgesics to help with
anxiety.
 During the healing process, antihistamines, massage, or transcutaneous
nerve stimulation may be used to aid with itching.
 Gabapentin can be use in those who do not improve with
antihistamines.
 Intravenous antibiotics are recommended before surgery for those with
extensive burns (>60% TBSA).
 In burns caused by hydrofluoric acid, calcium gluconate is a specific
antidote and may be used intravenously and/or topically.
 Recombinant human growth hormone (rhGH) in those with burns that
involve more than 40% of their body appears to speed healing without
affecting the risk of death

43. Surgery
 Skin grafting is done for Full-thickness burns
 Circumferential burns of the limbs or chest may need surgical
release of the skin, known as an escharotomy.
 This is done to treat or prevent problems with distal circulation,
or ventilation. It is uncertain if it is useful for neck or digit burns.
 Fasciotomies may be required for electrical burns

44. REFERENCE
 Wikipedia
 www.healthline.com
 www.mayoclinic.org

45. THANK YOU