I.6 GRADING
Gradation that indicates the severity of the disease is necessary for treatment options. There are various gradations of disease distribution patterns of acne vulgaris is presented. Pillsbury (1963) makes the following gradation:
Comedy in advanceBlackheads, papules, pustules, and more inflammation in the faceBlackheads, papules, pustules, and more inflammation in the face, chest, back.Konglobata acne.Frank (1970):
Non-acne komedonal inflamatorKomedonal acne inflamatorPapular acnePapular pustular acneRather severe acneSevere acneNodulo cystic acne / konglobataBurke and Cunliffe (1984)
Consisting of minor acne grading ¼, ½. ¾.Major acne consisting of gradation 1, 1 ¼, 1 ½, 1 ¾, 2, 2 ½, 3. 4, 5, 6, 7.Plewig and Kligman (1975):
Komedonal consisting of up gradation:If there are less than 10 blackheads from the face sideIf there are 10 to 24 of blackheadsWhen there are 25 to 50 of blackheadsWhen there are more than 50 blackheadsPopulopustul, which consists of grading:If there are no fewer than 10 lesions papulopustul from one side of the faceIf there are 10 to 20 lesions papulopustulWhen there are 21 to 30 lesions papulopustulIf there are more than 30 lesions papulopustulKonglobataAuthors (1982) in the Dermatology and Venereal School of Medicine / RSUPN Dr. Cipto Mangunkusumo make acne vulgaris graded as follows:
Lightweight, when: - a few lesions on a predilection not beradang- Some do not beradang lesion predilection in some places
- A few lesions on a predilection beradang
Currently, when: - A lot of the lesion was in a predilection beradang- Some do not beradang lesions on more than 1 predilection
- Some of the lesions was in a predilection beradang
- Beradang few lesions on more than 1 predilection
Weight, when: - Many do not beradang lesions on more than 1 predilection- Many more beradang on one or more predilection
Note: bit <5, a 5-10, many of> 10 lesions
Not beradang: blackheads and white, black comedones, papules
Beradang: pustules, lymph, cysts
I.7 DIAGNOSIS
Diagnosis of acne vulgaris and is established on the basis of clinical examination eksohleasi sebum, an expense the comedones clogging sebum ekstraltor (spoon Unna). Sebum that clogs foikel appear as solid masses such as candles or the like rice a softer tip sometimes black.
Histopathological examination showed a picture of a non-specific chronic inflammatory cell sebukan around foliel pilosebaceous with masses of sebum in the follicle. In the cysts, inflammation had disappeared to be replaced by the limiting mass of connective tissue liquid sebum mixed with blood, gained from death, and loose keratin.
Microbiological examination of microorganisms that have a role in the etiology and pathogenesis of the disease can be performed in microbiology laboratories equipped for research purposes, but the results are often unsatisfactory.
Examination and lipid composition of skin surface (skin surface lipids) can also be done for a similar purpose. In acne vulgaris levels of free fatty acids (free fatty acid) increases and therefore the prevention and treatment method is used to lower it.
I.8 DIAGNOSIS
Akneiformis eruption caused by the induction drugs, eg corticosteroids, INH, barbiturates, ACTH, and others. Clinical form of papulo eropsi sudden absence of comedones in almost all parts of the body. Can be accompanied by fever and can occur at any age.Venenata acne and acne due to physical stimuli. Generally monomorfi lesions, no itching, can be a blackhead or papule. With a predilection for on-site or contact chemical stimuli fisisnya.Rosacea (formerly: acne rosacea), is a chronic inflammatory disease in the face with the symptoms of erythema, pustules, telangiectasia and sometimes - sometimes accompanied by hypertrophy of sebaceous kelenjer. There are no blackheads except when combined with acne.Perioral dermatitis that occurs primarily in women polimofi premises clinical symptoms of erythema, papules, pustules, around the mouth that itch.I.9 MANAGEMENT
Treatment of acne vulgaris include efforts to prevent the occurrence of eruption (preventive) and attempt to get rid of acne that occurs (curative). Both of these efforts should be made simultaneously to remember that this anomaly occurs due to the influence of various factors (multifactorial), both internal factors of the body's own (racial, familial, hormonal), as well as external factors (food, seasons, stress) that sometimes - sometimes can not be avoided by the patient.
PREVENTION
Avoid an increase in the number lipis sebum and sebum content changes by way of: a) Diets low in fat and carbohydrates. Although it is debatable effectiveness, but if the anamnesis support, this can be done; b) skin care to cleanse skin of dirt surface microorganisms that have a role in the aetiopathogenesis of acne vulgaris.Avoid trigger factors of acne, for example: a) regular and healthy life, getting enough rest, exercise according to the condition of the body, avoid stress; b) the use of cosmetics to taste, both the number and duration; c) Avoiding kelenjer terpacunya oil, such as alcohol, spicy , smoking, unhealthy environment and so on.; d) Avoidance of dust pollution, pemencetan lege lesions that are not artists, which can aggravate the eruption that has occurred.Provide sufficient information to patients about the causes of disease, and old ways of prevention and treatment, and prognosis. It is important that patients do not underestimate or overestimate of business management that do that will make him despair or disappointment.
TREATMENT
Acne treatment can be done by way of delivering drugs - topical medications, systemic medications, surgery or combination skin the way - this way.
A. Topical treatmentTopical treatment to prevent formation of blackheads, suppress inflammation, and accelerate healing of lesions. Topical drug consisting of:
Irritants to the skin peeling (peeling), such as sulfur (4-8%), resosinol (1-5%), salicylic acid (2-5%), benzoyl peroxide (2.5 to 10%), vitamin A acid (0.025 to 0.1%), and azeleat acid (15-20%). End - the end is also used hidroka alpha acids (AHAs), such as glycolic acid (3-8%. Irritant drug side effects can be reduced by the use of - the heart begins with the lowest concentration.Topical antibiotics can reduce the amount of the topical miktoba etiopatogensis role in acne vulgaris, such as oxy tetrasilin (1%), eriteomisin (1%), clindamycin phosphate (1%).Anti-inflammatory topical ointment or cream with mild or moderate strength corticosteroid (hydrocortisone 1 to 2.5%) or intralesional corticosteroid injections strong (triamcinolone acetonide 10 mg / cc) in-cystic lesions nodulo.Others, such as ethyl lactate 10% to inhibit growth of microorganisms.B. Treatment of systemicSystemic treatment intended primarily to suppress the activity of microorganisms in addition can also reduce inflammation, suppress the production of sebum, and affects the hormonal balance. Systemic drug classes consist of:
Systemic anti-bacterial; tetracycline (250 mg - 1.0 g / day), eritmisin (4 × 250 mg / day), doxycycline 50 mg / day), trimethoprim 3 × 100 mg / day).Hormonal drugs to suppress androgen production and competitively occupy receptors in the target organ kelenjer sebaceous glands, such as estrogen (50 mg / day for 21 days a month) or the antiandrogen cyproterone acetate (2mg/hari). Treatment is aimed at adult women with acne vulgaris patients who failed beradang with other therapies. Systemic corticosteroids given to suppress inflammation and suppress the secretion of adrenal kelenjer, for example, prednisone (7.5 mg / day) or dexamethasone (0.25 to 0.5 mg / day).Vitamin A and oral retinoids. Vitamin A is used as antikeratinisasi (50 000 150 000 ui ui / day) has been rarely used as an acne medication because of side effects. Isotretinoin (0.5 - 1 mg / kg bw / day is a retinoid derivative that inhibits the production of sebum as an option on or konglobata nodulokistik acne that does not heal with other treatments.Other drugs, such as non-steroidal anti-inflammatory ibuprofen (600 mg / day), dapsone (2 × 100 mg / day), zinc sulfate (2 × 200 mg / day).C. Surgical skinSkin surgery sometimes - sometimes necessary to repair the scar tissue is mainly due to a severe inflammatory acne vulgaris that often lead to scarring, both the hypertrophic and the hipotrofik. Types of skin surgery tailored to the type and condition of scar tissue that occurs. Action after recovering vulgarisnya acne.
Surgical scalpel done to flatten the scar tissue that stands out or doing the elliptical excision of the scar tissue hipotrofik.Surgery performed on the electrical closed comedones to facilitate spending-nodulo sebum or on the cystic fluid drainage for the content that can speed up healing.Surgery chemistry with acetic acid or phenol triklor to flatten the lump of scar tissue.Surgery with frozen puree frozen CO2 or liquid N2 to accelerate the healing of inflammation.Dermabrasion to smooth hypo and hypertrophic scarring after extensive acne.
I. 10 Prognosis
Generally good prognosis of the disease. Acne vulgaris generally recover before reaching the age of 30-40 s. Acne vulgaris is rare that persisted until the parent or achieve gradation is very heavy so it needs to in-Inpatient care in hospitals.
I. 11 REFERENCES
Acne. Red Book
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