RAJIV GANDHI OF HEALTH SCIENCES,KARNATAKA,BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / Name of the candidates and address
(in block letters) / Dr.MAHADEVI PATIL
DEPARTMENT OF DERMATOLOGY,
VENEREOLOGY AND LEPROLOGY.
BASAVESHWAR TEACHING AND GENERAL
HOSPITAL,M.R.MEDICAL COLLEGE
GULBARGA - 585105
Permanent Address / C/O H.Y.MALIPATIL
SHARAN NILAY,10-934/56,
MAHALAXMI NAGAR,KALE LAYOUT,
GULBARGA-585103
2. / Name of Institution / H.K.E SOCIETY’S
MAHADEVAPPA RAMPURE MEDICAL
COLLEGE,GULBARGA-585105
3. / Course of study and subjects / M.D (DERMATOLOGY,VENEREOLOGY
AND LEPROLOGY)
4. / Date of admission to the course / 29/5/2010
5. / Title of topic / CLINICOEPIDEMIOLOGICAL AND TREATMENT OUTCOME OF VARIOUS TOPICAL MODALITIES IN ACNE VULGARIS
6. / Brief Resume of the intended work
6.1 / Need for the study
Acne vulgaris is one of the commonest inflammatory skin lesions encountered in patients attending dermatology out patient department. Acne is also putting psychosocial impact on patients, specially known problem in adolescents.
It is necessary to explore the burden of the disease in hospitals with clinical profile and treatment pattern from time to time. So, as to evaluate the clinico -epidemiological study and their outcome with various topical modalities of treatment for Acne vulgaris and to reduce adverse consequences like scars, the study is required. Hence the present study.
6.2 / Review of Literature
Definition
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit in adolescence characterised by comedones, papules, pustules, nodules, cysts and possibly scarring1.
Age of onset
Acne vulgaris may be present in the first few weeks and months of life,when a newborn is still under the influence of maternal hormones,this entity is called as Neonatal Acne. Adolescent acne usually begins with the onset of puberty,when the gonads begin to produce and release more androgen hormone.12% of women and 5% of men at age 25yrs have Acne.By age of 45yrs,5% of both men and women will hav Acne2.
Predisposing factors
Acne is multifactorial,but theories regarding dietary influences appear to be groundless.
  1. Hereditary
  2. Hormonal factors(oral contraceptives)
  3. Androgen stimulation
  4. Drugs like corticosteriods,Androgens,corticotrophins,Iodides,Bromides,Lithiumetc
  5. Exposure to heavy oils,greases and tars
  6. Trauma or rubbing from tight clothes
  7. Emotional stress
  8. Unfavourable climate
  9. Cosmetics3.

Distribution
Distribution of Acne lesion is confined to the areas with well defined sebaceous glands which includes the face, chest, back and upper arms4.
Types of lesions
Acne results in a variety of lesions.
  1. Open comedones (blackheads): Represent follicles with a widely dilated orifice.BlackColour is result of oxidation of melanin, interference in transmission of light through impacted epithelial cells or presence of certain lipids in the sebum.
  2. Closed comedones (whiteheads):they represent follicles that are dilated with cellularand lipid debris but possess only microscopic opening to the skin surface.
  3. Inflammatory papules and pustules.
  4. Nodules and cysts.
  5. Abscesses and scarring5.

Grades of acne vulgaris
Grade 1 (mild): comedones,occasional papules.
Grade 2 (moderate): comedones,many papules,few pustules.
Grade 3 (severe): predominanatly pustules,nodules, and abscesses.
Grade 4 (cystic): mainly cysts or abscesses,widespread scarring6.
Pathogenesis
  1. Excess sebum production is prerequisite for the development of Acne.
  2. Follicular epidermal hyperproliferation results in formation of primary lesion of Acne, the Microcomedones.
  3. Resident bacterial flora in sebaceous ducts namely Propionibacterium acnes,Propionibacterium granulosum, Pityrosporum ovale, Staphylococcus epidermis.
  4. Inflammation of blocked pilosebaceous duct with Propionibacterium acnes which aretrapped by cornified plaque with in follicular ducts7.

Diagnostic investigations
Diagnostic investigations are not necessary for the management of Acne vulgaris
If hyperandrogenism/PCOD is suspected,these are required.
  1. Total and free testosterone
  2. LH/FSH ratio
  3. Serum Dehydroepiandrosterone
  4. 17-hydroxyprogesterone
  5. Prolactin
  6. 24-hour urinary free cortisol8.

Treatment
1.Topical therapy
  1. Benzoyl peroxide 2.5% to 10% gel,lotion,cream,wash,bar
  2. Retinoids: Tretinion 0.025% gel,0.05% gel,0.1% gel
Adapalene 0.1% gel
Tazarotene 0.1% gel,cream available
  1. Topical antibiotics: Erythromycin 1.5 to 2% gel,lotion,
Clindamycin 1% gel,
Azithromycin gel
  1. Sodium sulfacetamide gel,lotion,wash
  2. Salicylic acid gel,cream,foam,solution
  3. Azelaic acid 20% cream,15% gel
  4. Combination of Benzoyl peroxide/Clindamycin/Adapalene/Tretinion.

2.Systemic therapy
a.Doxycyclin 50-100mg once or twice a day
b.Minocyclin 50-100mg once or twice a day
c. Tetracyclin 250-500mg one to four times a day
d. Macrolides: Erythromycin 250-500mg two to four times a day
Azithromycin 250-500mg once to twice a day
e.Oral retinoids: Isotretinione 0.5% to 1mg/kg/day
f.Trimethoprim sulfamethoxazole double strength dose once or twice a day
g.Hormonal therapy
1. Antiandrogens:spirinolactone 50-200mg in divided doses,
2. Cyproterone acetate, Flutamide.
3. Oral contraceptives
4. Gonadotrophin releasing hormone agonists.
3.Others
a. Phototherapy and Lasers
  1. Cryotherapy
  2. Surgery
  3. Chemical peeling
  4. Intralesional corticosteroids: Triamcinolone suspension 2.5 to 10mg/ml9,10.

Objectives of the study
Aims
  1. To find out and ascertain different clinical presentations of Acne vulgaris in both the sexes of various age groups.
  2. To confirm them with laboratory investigations if necessary.
  3. To find out the commonest to rarest Acne vulgaris presesntation.
  4. To find out the outcome of treatment with various topical modalities in various clinical types.

8. / Materials and methods
8.1 Source of Data
  1. Patients attending the skin O.P.D at Basaveshwar Teaching and General Hospital and Sangameshwar Hospital, Gulbarga.
  2. Reffered patients from other department of the above mentioned hospitals.

8.2 Methods of collection of data(including sampling procedure if any)
Inclusion criteria
  1. Patients attending skin O.P.D with features of Acne vulgaris
  2. Both sexes
  3. Age group above 10yrs
  4. Number of cases to be studied minimum of 100
  5. Duration of study: September 2010 to august 2012(2yrs).
Exclusion criteria
  1. Patients below 10yrs.
  2. Other infectious diseases on face.

8.3Does the study require any investigations or interventions to be
conducted on Patients or other humans or animals? If so please describe
briefly.
Yes
  1. Total and free testosterone
  2. LH/FSH ratio
  3. Serum Dehydroepiandrosterone(DHEA)
  4. 17 hydroxy progesterone
  5. Prolactin
  6. 24 hr urinary free cortisol.

8.4 Has ethical clearance been obtained from institution in case of 8.3?
Yes: Ethical clearance has been obtained from “Ethical clearance committee of the
Institution.
8.5References
  1. William D James,Timothy G Berger,Dirk M Elston.Chapter13:Acne from Andrew’s Diseases of the skin,Clinical Dermatology,10th edition,2006;p232.
  2. Kligman AM.Postadolescent acne in women.Cutis.Jul1991;48(1):75-7.
  3. Acne vulgaris: Causes and incidence (Professional Guide to Diseases (Eighth Edition)) read wrongdiagnosis.com/a/acne_vulgaris/causes.htm.
  4. Tan JK, Vasey K, Fung KY. Beliefs and Perceptions of patients with acne. J AM Acad Dermatol 2001;44:439-45.
  5. 'Acne vulgaris', The symptoms of acne,British Medical Journal, Vol 325, pp. 475-479.
  6. R.G.Valia,Ameet.R.Valia,chapter 27,Acne,Rosacea and Perioral Dermatitis from IADVL Textbook of Dermatology,3rd edition,2010.vol1,p.842-3.
  7. Tony Burns,Stephen Breathnach,Neilcon Christopher Griffiths,chapter 42:Disorders of Sebaceous glands:Acne vulgaris from “Rooks Textbook of Dermatology”,vol 2,8th edition,2010;p.42.17.
  8. A Hatwal, SK Singh, JK Agarwal, G Singh, HS Bajpai, SS Gupta Indian Journal of Dermatology, Venereology, and Leprology, Year 1990, Volume 56, Issue 6.
  9. Andrea L Zaenglein and Diane M Thiboutot.Chapter 37:acne vulgaris from Jean L Bolognia,Joseph L Jorizzo,Ronald P Rapins Dermatology,vol 1,2nd edition,2008,p.504.
  10. Andrea L Zaenglein,Emmy M Graber,Diane M Thiboutot,John S Strauss.Chapter 78:Acne Vulgaris and Acneiform eruptions from Fitzpatrick’s Dermatology in General Medicine,volume 1,7th edition,2008;p.696.

10. / Signature of Candidates
11. / Remarks of Guide / This study helps to solve the common problem in Adolescents of present generation.
12. / 12.1 / Name and designation of the
(In block letters)
Guide / DR.V.K.WALI
M.D(SKIN AND V.D),D.V.D
PROFESSOR,
DEPARTMENT OF SKIN AND VD
M.R.MEDICAL COLLEGE,
GULBARGA
12.2 / Signature
12.3 / Co-guide
12.4 / Signature
12.5 / Head of the Department / Dr.S.K.PATIL
M.D.(SKIN AND VD)
PROFESSOR AND HEAD,
DEPARTMENT OF SKIN AND VD
M.R.MEDICAL COLLEGE,
GULBARGA
12.6 / Signature
13 / 13.1 / Remarks of the chairman and principal
13.2 / Signature