Entrust Skinovate to effectively treat your skin. We provide an extensive range of Skin Peels and acne treatments to improve pigmentation, texture, feel and skin tone. http://www.skinovate.com.au/treatments/clear-skin-treatments/

1. ACNE Overview
Dr Paul Spano
Cosmetic Physician

2. ACNE Pathology
• Chronic Inflammation - Pilosebaceous Unit
• Abnormal Keratinizaton in Hair Follicle
• Increased Follicular Epithelial Turnover
• High Sebum Production
• Follicle Blockage = Comedone
– Non-Inflammatory
• Propionibacterium acnes
– Chemical Inflammation

3. General Factors
• Diet - Unconfirmed • Endocrine
• Cosmetics • Androgens
• PCOS
• Oil
• Pre-menstrual Flare
• Irritation
• Summer • Drugs
• Steroids
• UV light
• OCP
• Salt water
• Stress • Occupation
• Sweating
• Common Association
• Oils
• Picking

4. Aims of Treatment
• Unblocking the Comedones
• Reducing Sebaceous Gland activity
• Reducing Bacterial Count
• Reducing Inflammation
• Cosmesis Short Term - Pimples
• Cosmesis Long Term - Scarring

5. Treatment
• TOPICAL • SYSTEMIC
– Keratolytics – Antibiotics
• Salicylic Acid • Antibacterial
• Azealic Acid • Antiinflammatory
– Retinoids • Resistance
• Tretinoin • Side Effects
• Adapalene • eg Minocycline
(Dizziness, Ataxia,
– Anti-Bacterial Pigmentation,
• Benzoyl peroxide Headache)
• Topical Antibiotics – Hormones
• Cyproterone
– Spironolactone
• Antiandrogen

6. Roaccutane
• 4-6 months oral therapy
• 20% need second course
• Teratogenic
• Side Effects ++++++++
• Linked to Teenage Suicide via Depression
and Psychoses

7. Vitamin A
• Group of compounds
• Cellular differentiaion, organ development
and pigment production (retina)
• Immune function, Antiinflammatory
• all Trans Retinoic acid (Tretinoin)

8. Roaccutane - M.O.A.
• Inhibits Vit. A metabolism in skin
• Vit A levels increase by 50% in Epidermis
• Sebosuppressive
• 90% red. In gland size, proliferation
• Inhibits Keratinocyte numbers
• Less follicle blockage
• increased water loss - barrier loss
• Inhibits Bacterial Growth
• Antiinflammatory

9. Roaccutane - Precautions
• Contraindicated
• Pregnancy and Lactation
• Severe Hepatic or Renal Failure
• Relative Contraindications
• Hyperlipideamia
• Diabetes
• Severe Osteoporosis
• Co-medication
• Vit A - Incresed Toxicity
• Tetracyclines - Cranial Hypertension
• Regular Aspirin/NSAIDS - Mucosal damage

10. Roaccutane - Adverse Effects
Dose Dependent, Reversible
• Cheilitis 80%
• Itching 25%
• Facial Dermatitis 40%
• Skin Fragility 20%
• Xerosis (Dry Skin) • Waxing, Shaving
40% • Abrasive therapy
• Photosensitivity 100% • Desquamation 15%
• Dry Mucosa 40% • Hair Loss 15%
• Conjunctivitis 30% • Retinoid Dermatitis
• Epistaxis 25% • Depression / Psychosis
• I.B.D.
• Flare / Scarring ++

11. Roaccutane - Adverse Effects 2
• Eyes and Pseudotumour cerebri
• Dryness / Contact Lenses
• Corneal opacities, Cataract
• Pseud. C. with Tetracycline
• Lipids and Liver
• Hypertriglyceridaemia, Hypercholesterolaemia
• Reduced HDL, Hepatic enzyme disruption
• Arthralgia / Myalgia 5%
• Young Adults, can be severe
• +/- Ligament calcification

12. Roaccutane Adverse Effects 3
• Long Term Toxicity - Bone
• Vitamin A intoxication
• > 2 yrs treatment
• hyperostosis, periostosis, demineralization
• premature epiphyseal closure
• Irreversible
• Teratogenicity
• OPC 1 month before and 3 months after
• Pregnancy Testing
• Monitoring
• LFT , ESR, Glucose, Lipids

13. Roaccutane cont.
• Links to Teenage Suicide
• Jick Study by Roche to dispel concerns
• Poorly designed
• Raised more concerns
• Depression 20% incidence
• ? Roaccutaanes role

16. Modern Treatments
• Microdermabrasion
• Crystal Abrasion
• Suction / Oxygenation
• Home exfoliation / AHA / BHA
• Chemical Peels
• Keratolytic
• Exfoliants

17. Remember…….
• Emotional Support
• Complex Disease
• Concurrent Multiple Treatments
• Antibiotic Resistance
• Roaccutane not a Panacea