tailieunhanh - Paediatrics & Child Health - part 2

Viêm ống pilosebaceous. Phân loại là nhẹ, trung bình, và nặng. Một trẻ vị thành niên: mụn trứng cá: "Sản xuất bã nhờn: androgen kích thích các đơn vị pilosebaceous siêu đáp ứng Khiếm bình thường dòng chảy của bã nhờn: Tắc nghẽn của ống pilosebaceous do tăng sừng Propioni vi khuẩn mụn trứng cá: | Acne vulgaris 5 D Inflammation of the pilosebaceous duct. Classified as mild moderate and severe. A Adolescent acne Sebum production androgenic stimulation of hyper-responsive pilosebac-eous units. Impaired normal flow of sebum obstruction of the pilosebaceous duct by hyperkeratosis. Propioni acne bacteria may play a role by producing cytokines and lipolytic enzymes. Infantile acne 3 months of life transient and usually due to maternal androgens. A R Puberty may premenstrually POS excess cortisol Cushing syndrome . E Developed world affects 79-95 of the adolescent population peaking at 14-18 years tends to recede by early twenties. Developing world acne incidence is considerably lower likely combination of environmental and genetic factors. _H Usually self-diagnosed acute onset greasy skin may be painful. E Open comedones whiteheads flesh-coloured papules. Closed comedones blackheads black colour is due to oxidation of the melanin pigment. Other features pustules nodules cysts scarring and seborrhoea. Distribution primarily affects the face neck chest and back where sebaceous glands are most numerous . P Gross distension of the pilosebaceous follicle with neutrophil infiltration. Closed comedones may contain serous fluid. Severe acne can create fistulae between inflamed glands. Normally none required. Investigate for endocrine disorder if acne develops during 2-10 years of age. Bloods FSH LH if female suspect POS . Urine 24-h-urinary cortisol if Cushing syndrome is suspected . M Many cases may not need treatment. Indication for treatment based on classification and degree of psychosocial impact. In severe acne therapy should be commenced early to prevent scarring. Topical preparations 1 Benzoyl peroxide keratolytic agent encourages skin peeling and number of P. acnes S E irritation and bleaching of clothes . 2 Vitamin A derivatives tretinoin may take 3-4 months to work. 3 Azelaic acid. Antibiotics 1 Topical clindamycin erythromycin. 2 Systemic tetracycline only in