COSMETICS

Acne vulgaris &

Anti- acne products

Dr. Lilian Hameed Matti

M. Sc. Pharmaceutics
• Acne vulgaris :is a common dermatological disorder of
the pilosebaceous unit that has a complex pathophysiology
and can be triggered by a number of factors,

• Acne affect all skin types, and all age groups (more in group
age 12-24)

• Acne occurs when the hair follicles become plugged with oil
and dead skin cells.
❖The pathogenesis of acne vulgaris can be attributed to multiple factors.
✓Increased sebum production by the pilosebaceous unit

✓ Increased androgen activity

✓ Abnormally increased keratinocyte production and desquamation with subsequent

plugging of the follicles.

✓Microbial colonization of the pilosebaceous unit by Propionibacterium acnes (P. acnes)

✓Inflammation and immune reactions.

 Sebum

Inflammation,
immune Androgens
reactions

ACNE

P. acnes Hyper keratinization

 Types of Acne Vulgaris
• The clinical presentation of acne can range from mild comedonal ( non-inflammatory)
form to severe inflammatory cystic acne.

❑Non-inflammatory lesions

• Open and closed comedones, which are not inflamed and red because the follicle walls
are intact, these lesions are large enough to be seen by the naked eye.

✓Blackheads, known as open comedones, are follicles that have a wider opening filled
with sebum and dead cells.

• They are called blackheads due to the dark appearance (exposure of the top of the
comedo to oxygen) of the plugs in the follicles.

• Open comedones rarely develop into inflammatory lesions.

 Types of Acne Vulgaris
✓Whiteheads, known as closed comedones.
• Occur when the follicle’s opening remains closed.
• They are more difficult to see and they usually have normal skin color.
• It is much more likely to progress into an inflammatory lesion than an open
comedo.
 Types of Acne Vulgaris
❑Inflammatory acne lesions: They are red and inflamed due to blood penetrating the follicle after the follicle has
ruptured.

✓ Papules are small, raised, usually red, and tender bumps under the skin.

✓ Pustules are red, tender bumps with white pus at their tips.

✓ Nodule is a deep lesion, similar to a papule, but much deeper in the dermis, hard to touch, more painful than
other lesion types, and deep red or purple in color.

✓ Cyst is a large pus-filled lesion that is the result of a severe inflammatory reaction. As it affects deeper layers of
the skin, cystic acne frequently causes scarring.
• On basis for selecting the treatment, Acne is categorized into:
✓ Mild acne : limited to the face and is characterized by the presence of noninflammatory closed and
open comedones with few inflammatory lesions.

✓ Moderate acne: characterized by an increased number of inflammatory papules and pustules on

the face and also often affects other body parts.

✓ Severe acne :nodules and cysts are present. In these cases, facial lesions are often accompanied by
widespread disease of other body parts, including the neck, chest, and back
 Treatment of Acne Vulgaris
➢ Topical Treatment includes:

❖Benzoyl Peroxide (BPO): It is a nonantibiotic antimicrobial agent that can kill bacteria within the clogged pore.

• It increases cell turnover, cleans pores, desquamates the skin, and also has anti-inflammatory properties.

• It is used for mild-to-moderate acne,

• BPO is available as topical OTC products in a concentration of 2.5–10% in various forms, including creams,
gels, and lotions, and facial wash.

• often combined with antibiotics and/or retinoids.

• Its main side effects include peeling, dryness, burning, and redness of the skin.
 Treatment of Acne Vulgaris
❖Salicylic Acid (SA): has desquamating and comedolytic properties.

• SA is an option for patients who cannot tolerate a topical retinoid due to skin irritation.

• It is available as OTC products in concentrations of 0.5–2% in various product forms

• Temporary typical side effects: skin dryness, redness, scaling, itching, and burning.

o The term “comedolytic” means lysis (i.e., disintegration) of a comedo via lysis of plugged corneocytes, whereas
keratolytic is defined as the lysis of superficial corneocytes, nails, and hair via lysis of keratin .
 Treatment of Acne Vulgaris
❖Topical Retinoids: They are vitamin A derivatives.

• They act by: Normalize the irregular shedding of skin cells within sebaceous follicles, reduce
the cohesion among keratinocytes in the follicles, and hinder the development of new
microcomedones.

• They are used as monotherapy ( in Mild noninflammatory comedonal acne) or in combination

with antimicrobial therapy or BPO (in inflammatory lesion).
• Currently available FDA-approved topical retinoids include tretinoin,
adapalane, and tazarotene.

• their side effects, including transient skin irritation, burning sensation,

redness, itching, and peeling.

• Improvement of acne symptoms usually occurs within weeks, and the

maximum benefit can be typically expected after 3–4 months of treatment.

• It’s a prescription- only drug.

 Treatment of Acne Vulgaris

❖Topical Antibiotics: They are used for mild-to-moderate acne when inflammatory lesions are present.

• The commonly used antibiotics for acne include clindamycin and erythromycin.

• Current guidelines recommend combining antibiotics with retinoids and/or BPO, BPO can minimize
bacterial resistance, while retinoids can provide synergistic comedolytic and anti-inflammatory
properties.
 Treatment of Acne Vulgaris

❖Resorcinol and sulfur: These active ingredients are

generally available as creams, masks, ointments, and soap
bars.
• Sulfur helps dry out the surface of your skin to help absorb excess oil
(sebum) that may contribute to acne breakouts. It also dries out
dead skin cells to help unclog your pores.
 Treatment of Acne Vulgaris

• Azelaic acid: Topical ingredients, It is an alternative to retinoids that has comedolytic,

antimicrobial, and anti-inflammatory properties.

• when applied topically in a cream formulation of 20%, t works in part by stopping the growth of
skin bacteria that cause acne, and by keeping skin pores clear, It also decreases the production
of keratin, which is a natural substance that promotes the growth of acne bacteria.

• For the topical treatment of mild-to-moderate inflammatory acne vulgaris.

 Treatment of Acne Vulgaris
➢ Systemic Treatment Includes:

❖Oral Antibiotics: for moderate and severe acne.

• doxycycline, minocycline, tetracycline, and erythromycin are most commonly used.

• oral antibiotics should be combined with other agents to minimize the development of
bacterial resistance and improve treatment efficacy (with topical retinoids or BPO).
• side effects: upset stomach, dizziness, or skin discoloration.

• Doxycycline can increase sun sensitivity, tetracyclines can cause teeth discoloration,
while minocyline can lead to skin hyperpigmentation.
 Treatment of Acne Vulgaris
❖Hormonal Therapy:

• Hormonal therapy is a useful adjunct therapy (rather than a stand-alone therapy) in women with
moderate-to-severe acne.

• Hormonal agents commonly used :

✓ combination oral contraceptives containing both an estrogen and a progestin (suppress ovarian
androgen production).

✓ androgen receptor blockers ( block the effect of androgens on the sebaceous gland).

• Common side effects of hormonal therapy include headache, breast tenderness, nausea, and depression
 Treatment of Acne Vulgaris

❖Isotretinoin: is an oral retinoid, it is a powerful medication for the treatment of severe

acne and moderate acne that does not respond to other treatments.

• Isotretinoin targets all major components involved in the development of acne:

normalizes follicular desquamation, decreases sebum secretion, inhibits the growth of P.
acnes, and exerts anti-inflammatory effects.

• it is usually used as a monotherapy.

• The common side effects caused by isotretinoin include dryness of the skin, eyes, mouth,
lips, and nose ,itching, nosebleed, muscle ache, sun sensitivity and poor night vision
 Treatment of Acne Vulgaris

➢Additional Treatments

❖Chemical peels Both AHA-based and BHA-based peeling preparations and glycolic acid.

❖Comedo Extraction squeezing with fingertips and using a comedo extractor.

❖Optical therapies broad-spectrum continuous-wave visible light (blue and red), intense
pulsed light, pulsed dye lasers, potassium titanyl phosphate lasers, photodynamic therapy
(PDT), and pulsed diode laser.

❖herbal and alternative therapies aloe vera, fruit-derived acids, and tea tree oil.

❖Dietary restriction.