ACNE AND BURNS

PRESENTED BY: SHIKHA .N.

BARSAINYA(14MPH703)

CLINICAL PHARMACY

INSTITUTE OF PHARMACY, NIRMA

UNIVERSITY.

ACNE

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.

Acne usually appears on your

face

neck

chest

back

shoulders

The resulting appearance may lead to

Anxiety

reduced self-esteem

depression

thoughts of suicide.

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.

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

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

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.

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.

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)

Pathogenesis:

Acne vulgaris is a disease of pilosebaceous follicles.

Factors:

Retention hyperkeratosis.

Increased sebum production.

Propionibacterium acnes

within the follicle.

Inflammation

Initial pathogenesis (reason

unknown):

follicular hyperkeratinization

proliferation +

decreased desquamation of

keratinocytes

hyperkeratotic plug

(microcomedone)

Pathogenesis

Sebaceous glands enlarge

Sebum production increases

Growth medium for P. Acnes

plugs provide anaerobic

Lipid-rich environment

Pathogenesis

Bacteria thrive

Inflammation results

Chemotactic factors attract neutrophils

Depending on conditions

Non-inflammatory

open/closed comedones

Inflammatory papule/

pustule/nodule

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).

Treatment Lifestyle and home remedies:

Wash problem areas with a gentle cleanser

Over-the-counter acne products to dry excess oil and promote peeling: egproduct 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

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).

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.

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.

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.

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

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

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Types of burns

There are three primary types of burns:

First

second

third-degree

First-Degree BurnFirst-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.

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

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.

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

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

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.

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.

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.

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

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

Lund Browder Chart used for determining

BSA

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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%

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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%

TBSAYoung or old >10% TBSA

<2% full thickness burn2–5% full thickness

burn>5% full thickness burn

High voltage injury High voltage burn

Possible inhalation

injuryKnown inhalation injury

Circumferential burnSignificant burn to face,

joints, hands or feet

Other health problems Associated injuries

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.

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.

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.

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.

MedicationsPain 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

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

REFERENCE

Wikipedia

www.healthline.com

www.mayoclinic.org

THANK YOU