Physical Therapies in Acne Vulgaris

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Information about Physical Therapies in Acne Vulgaris
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Published on July 29, 2009

Author: d_talreja

Source: authorstream.com

ROLE OF ISOTRETINOIN AND PHYSICAL THERAPIES IN ACNE VULGARIS : ROLE OF ISOTRETINOIN AND PHYSICAL THERAPIES IN ACNE VULGARIS By: Dr. Deepak Kumar ISOTRETINOIN : Isotretinoin Vitamin A derivative Binds to RAR receptor Effects Reduces sebum production Comedogenesis Colonization of P.acnes Anti-inflammatory ISOTRETINOIN ISOTRETINOIN : Indication Severe nodular acne Acne resistant to conventional treatments Persisted beyond the age of 25 years ISOTRETINOIN ISOTRETINOIN : Usual dose 0.5–1.0 mg/kg /day For 16–30 weeks Total of 120 mg/kg Low-dose courses Adults with persistent acne Late-onset acne 0.5 mg/kg/day taken 1 week out of 4 For 6 months ISOTRETINOIN ISOTRETINOIN : INITIATION AND MONITORING Females with childbearing potential Negative pregnancy test Initiat on third day Normal menstrual period Contraception During treatment 1 month before/after ISOTRETINOIN ISOTRETINOIN : SIDE EFFECTS Teratogenic Spontaneous abortion Cardiovascular ASD VSD Mood changes Depression Excessive anger Liver function tests Transaminase ?× 3 Lipid profile Triglyceride ? 800 mg/dL ISOTRETINOIN Discontinue isotretinoin ISOTRETINOIN : ISOTRETINOIN PHYSICAL THERAPIES : PHYSICAL THERAPIES ELECTROCAUTERY : Electrical current passes through tissue Heat produced Tissue destruction Indication Macrocomedones ELECTROCAUTERY ELECTROCAUTERY : Method Local anesthetic EMLA For 60–75 min Cautery at low setting Complication Very little scarring Post-inflammatory pigmentation ELECTROCAUTERY PHOTOTHERAPY : Natural sunlight Broad-spectrum sunlamp Blue light PHOTOTHERAPY PHOTOTHERAPY : DESTRUCTION OF P.ACNES P.acnes Synthesizes intracellular porphyrins Absorbs light Singlet oxygen Attacks cell membrane PHOTOTHERAPY PHOTOTHERAPY : BLUE LIGHT THERAPY(415 NM) Two 15 min sessions per week For 4 weeks Follow-ups 1- and 3-month Inflammatory acne 80% patients responded 60% reduction in lesions PHOTOTHERAPY PHOTOTHERAPY : PHOTOTHERAPY Before blue light After PHOTODYNAMIC THERAPY : Photosensitizer Light source Molecular oxygen PHOTODYNAMIC THERAPY PHOTODYNAMIC THERAPY : Amino laevulinic acid (ALA) Absorbed by Pilosebaceous glands Actinically damaged skin Skin cancer cells Absorbs light in the 415- to 630-nm range Damage the sebaceous glands Sebum suppression Decrease in P. acnes PHOTODYNAMIC THERAPY PHOTODYNAMIC THERAPY : Technique Wash the face Apply ALA Wait Wash the face Phototherapy PHOTODYNAMIC THERAPY PHOTODYNAMIC THERAPY : TOPICAL (ALA) PLUS BROAD-BAND LIGHT (550–700 NM) Inflammatory acne Clinical clearance in 4 weeks Persisted up to 20 weeks Side effects Acneform folliculitis Post inflammatory hyperpigmentation PHOTODYNAMIC THERAPY PHOTODYNAMIC THERAPY : SHORT-CONTACT ALA AND BLUE LIGHT Four weekly treatments moderate to severe acne No noted adverse effects Faster than lasers or light therapy alone PHOTODYNAMIC THERAPY LASER : LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION Pumping source Laser chamber Laser medium CO2 Nd:YAG Delivery system LASER LASER : LASER SAFETY Eye protection glasses Eye cups Inhalation of smoke Face mask Smoke evacuator LASER LASER : Laser Beam Continuous Pulsed Quality switched (Q-switched) LASER LASER : LASER Scaterring Change in direction Absorption Thermal injury LASERS : LASERS Chromophores Absorbs light Selective photothermolysis Target Specific wavelength Short pulse duration Thermal relaxation time LASERS : LASERS LASERS : LASERS Tissue cooling Epidermal melanin Absorb light Direct Back-scattered Cooling the epidermis Heat damage to skin Blistering Dyspigmentation Scarring LASERS : 1450-NM LASER Inflammatory acne lesions Thermal damage Upper dermis Sebaceous glands 810-NM DIODE LASER + INDOCYANIN GREEN Sebaceous glands Absorbs indocyanin green LASERS LASERS : CO2 LASER AND ERBIUM:YAG LASERS Laser resurfacing Light strikes skin Heated layer 300°C Vaporization of layer Reepithelialization Atrophic acne scars LASERS CRYOTHERAPY : Cryotherapy Cell death Ice crystals in cell Osmotic differences Cold injury to small blood vessels Immunological stimulation CRYOTHERAPY CRYOTHERAPY : FREEZ-THAW CYCLE Freezing Intracellular ice Thawing Re-crystallization Disrupt cell membranes Ice melts Cell lysis CRYOTHERAPY CRYOTHERAPY : EQUIPMENT Spray method Spray tip size Freeze times Longer Shorter Freeze margin Superficial lesions -3 mm Deep lesions-5 mm Cryoprobe Dipstick technique CRYOTHERAPY CRYOTHERAPY : CRYOTHERAPY METHODS CRYOTHERAPY : LIQUID NITROGEN Temperature -195°C Chronic nodular acne Two freeze–thaw cycles 15–30 s Keloid acne scar CRYOTHERAPY CRYOTHERAPY : Postoperative care Rinse Soap and water Edema Vesicles Bullae Weeping lesion Bandage CRYOTHERAPY CRYOTHERAPY : Complication Pain Analgesics Hypopigmentation Topical steroids Nerve Damage CRYOTHERAPY CHEMICAL PEELING : Controlled application Exfoliating agents CHEMICAL PEELING CHEMICAL PEELING : GLYCOLIC ACID (ALPHA-HYDROXY ACID) Keratolytic Anti-inflammatory Technique Clean the face Apply rapidly 3 min duration Neutralize CHEMICAL PEELING CHEMICAL PEELING : 70% GLYCOLIC ACID Weekly Six applications Papulo-pustular Acne Atrophic acne scars CHEMICAL PEELING CHEMICAL PEELING : CHEMICAL PEELING Before 70% glycolic acid After CHEMICAL PEELING : CHEMICAL PEELING Before 70% glycolic acid After Chemical peeling : Post-peeling Complication Burning Itching Hyperpigmentation Infection Contraindication Contact dermatitis Pregnancy Chemical peeling Rare CHEMICAL PEELING : SALICYLIC ACID Keratolytic Comedolytic Anti-inflammatory Antimicrobial Indication Acne Inflammatory Non-inflammatory lesions CHEMICAL PEELING CHEMICAL PEELING : SALICYLIC ACID Contraindications Active inflammation/dermatitis Acute viral infection Pregnancy Isotretinoin therapy 2 weeks before 30% SALICYLIC ACID IN ETHANOL Six peels 2- to 4-week intervals CHEMICAL PEELING CHEMICAL PEELING : CHEMICAL PEELING Before 30% salicylic acid After CHEMICAL PEELING : SALICYLIC ACID Complications desquamation Irritation hyperpigmentation CHEMICAL PEELING Topical steroids INTRALESIONAL STEROID : TRIAMCINOLONE ACETONIDE Cystic acne 2.5 mg/mL Keloids 40 mg/mL Every 2 weeks Local side effects Collagen atrophy Hypopigmentation Skin necrosis Telangiectasia INTRALESIONAL STEROID DERMABRASION : DERMABRASION Mechanical removal Epidermis and dermis Controlled fashion Re-epithelialization 7 to 10 days Indication Atrophic acne scars DERMABRASION DERMABRASION : Technique Clean Freez Abrasion Diamond fraise Depth Pinpoint bleeding (papillary dermis) Whitish yellow (reticular dermis ) Dressing DERMABRASION DERMABRASION : Complications Infections Hypopigmentation Scarring DERMABRASION SOFT-TISSUE AUGMENTATION : Bovine collagen injection Zyderm II Acne scars Skin allergy test Upper reticular dermis Repeat 6 months SOFT-TISSUE AUGMENTATION SOFT-TISSUE AUGMENTATION : SOFT-TISSUE AUGMENTATION Complication Delayed hypersensitivity Granulomatous reactions Sterile abscess Intralesional steroid Oral antibiotics THANK YOU : THANK YOU

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