CURRICULUM VITAE

Identitas Pribadi :
Nama : Dr.dr. Imam Budi Putra, MHA, SpKK, FINSDV, FAADV
NIP : 196507252005011001
NIDN : 0025076506
Pangkat dan Golongan ruang/TMT : Penata, Golongan III-C
Tempat/Tanggal Lahir : Medan/ 25 Juli 1965
Fakultas/Jurusan : Departemen Ilmu Kesehatan Kulit dan Kelamin
Fakultas Kedokteran Universitas Sumatera Utara
Pendidikan Tertinggi : Doktor (S3),Ilmu Kedokteran
Universitas Sumatera Utara, Medan
 Riwayat Pendidikan

S1 : Fakultas Kedokteran USU, 1991

S2 : Master of Hospital Administration. American
Institute of Management Studies, 2002
Sp1 : Spesialis Kulit dan Kelamin FK USU, 2006
S3 : Doktor (S3) Ilmu Kedokteran FK-USU, 2012
 Riwayat Pekerjaan

1. Wakil Dekan I Fakultas Kedokteran Universitas Sumatera Utara Medan 2016 s/d Sekarang.
2. Anggota Senat Akademik Universitas Sumatera Utara Medan Tahun 2015 s/d Sekarang.
3. Wakil Ketua Komisi Evaluasi Kurikulum, Kolegium Dokter Indonesia 2018 – 2021.
4. Ketua Komite Medik Rumah Sakit Pendidikan Universitas Sumatera Utara Medan 2015 s/d
Sekarang.
5. Pelaksana Tugas Ketua Program Studi Ilmu Kesehatan Kulit dan Kelamin FK USU tahun
2017-Sekarang.
6. Dosen S3 (Program Doktor) Ilmu Kedokteran Fakultas Kedokteran Universitas Sumatera
Utara Medan 2015 s/d Sekarang.
7. Staff Ahli Dekan Bidang Pendidikan Fakultas Kedokteran Universitas Sumatera Utara
Medan 2009 s/d 2015.
8. Sekretaris Program Studi Ilmu Kes. Kulit & Kelamin FK USU, 2007-2009.
9. Ketua Divisi Tumor dan Bedah Kulit, Ilmu Kesehatan Kulit dan Kelamin FK USU 2006 s/d
Sekarang.
10. Dosen /Staf Pengajar Tetap Divisi Tumor dan Bedah Kulit, Ilmu Kesehatan Kulit dan
Kelamin FK USU 2006 s/d Sekarang.
11. Dosen /Staf Pengajar Tetap FK USU, 2005 s/d Sekarang.
 Organisasi :
1. Ketua Perhimpunan Dokter Spesialis Kulit dan Kelamin PERDOSKI Cabang Medan.
2017 – 2020.
2. Anggota Dewan Pakar Ikatan Dokter Indonesia (IDI) Wilayah Sumatera Utara. 2016
– Sekarang.
3. Anggota Dewan Pakar Ikatan Dokter Indonesia (IDI) Cabang Medan. 2016 –
Sekarang.
4. Pengurus Bidang Penjaminan Mutu Pelayanan Kesehatan Ikatan Dokter Indonesia
(IDI) Cabang Medan. 2014 – 2017.
5. Anggota Ikatan Dokter Indonesia (IDI) Cabang Medan. sampai sekarang .
6. Wakil Ketua Majelis Pengembangan dan Pelayanan Keprofesian IDI Wilayah
7. Sumatera Utara Periode 2013 – 2016.
8. Pengurus Perhimpunan Dokter Spesialis Kulit dan Kelamin PERDOSKI Cabang
9. Medan Bidang Pengembangan dan Pelayanan Keprofesian tahun 2009 s/d 2014.
10. Anggota Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI)
11. Cabang Medan. sampai sekarang.
12. Anggota Kelompok Studi Dermatologi Anak Indonesia. sampai sekarang.
13. Anggota Kelompok Studi Tumor dan Bedah Kulit Indonesia. sampai sekarang.
14. Anggota Kelompok Studi Dermatologi Kosmetik Indonesia. sampai sekarang.
15. Anggota Kelompok Studi LASER Indonesia. sampai sekarang.
16. Anggota Kelompok Studi Geriatri Indonesia. sampai sekarang.
Publikasi Internasional Terindeks di Scopus & Thomson Reuters :
1. Open Access Maccedonia Journal of Medical Science, E-ISSN 1857-9655, Vol.7, No.9, 2019,
Utilisation of Cryolipolysis among Asians : A Review on Efficacy and safety.
2. Bali Medical Journal, http://dx.doi.org/10.15562/bmj.v8i3.1514, Vol.8, No. 3, 2019,
Correlation between Interleukin-10 (IL-10) serum level with acne vulgaris severity.
3.Bali Medical Journal, P-ISSN : 2089-1180, E-ISSN. 2302-2914, Vol.8, No. 2, 2019, Analysis of
nerve growth factor serum levels in psoriasis vulagris patients
4.Bali Medical Journal , P-ISSN : 2089-1180 E-ISSN : 2302-2914, Vol. 8, No.2, 2019, Correlation
between verruca vulgaris and superoxide dismutase
5. Bali Medical Journal, P-ISSN : 2089-1180, E-ISSN : 2302-2914, Vol. 8, No. 1, 2019 , Analysis
of serum 25-Hydroxyvitamin D level in Keloid patients
6. Open Access Maccedonia Journal of Medical Science, E-ISSN 1857-9655, Vol.7, No.1, 2019,
Correlation between Serum Leptin Levels with Type and Number of Lesion Skin Tag.
7. Open Access Maccedonia Journal of Medical Science, E-ISSN :1857-9655, Vol.7 , No.4, 2019,
The Effect of Puguntano Leaf Extract (curanga Fel-Terrae Merr.) On P38 Mapk Levels and
Glut-4 Expressin inType 2 diabetic Rat Mescle.
8. Bali Medical Journal, P-ISSN : 20891180, E-ISSN : 2302-2914, Vol. 7, No. 3, 2018, Melasma
Characteristic in Hormonal Contraceptive Acceptors at Kelurahan Mangga Kecamatan
Medan Tuntungan, Medan-Indonesia.
9. Bali Medical Journal, P-ISSN : 20891180, E-ISSN : 2302-2914, Vol. 7, No. 2, 2018,
Dermatophytes and Bacterial Superinfections in Tinea Pedis Patients at Haji Adam Malik
Central Hospital, Medan-Indonesia.
10.Bali Medical Journal, P-ISSN : 20891180, E-ISSN : 2302-2914, Vol. 7, No. 3, 2018, Quality of
Life Onychomycosis Patients at H. Adam Malik Genreal Hospital, Medan – Indonesia, 2016.
11.Open Access Maced J Med Sci Electronic Ahead of Print,ISSN : 1857-9655, Vol. 5, No. 3,11
Juni 2015, The Correlation Between Body Mass Index with the Ocurrence of Skin Tag.
12.Open Access Maccedonia Journal of Medical Science,ISSN : 1857-9655, Vol. 5, No. 3, Juni
2015, Correlation Between Serum Homocysteine and Vintiligo Area Scoring Index.
Publikasi Makalah Internasional (SUMEJ) :
1. Sumatera Medical Journal, ISSN : 2622-9234, ISSN (Online) : 2622-1357,
Vol.1, No.1, 2018 , Quality of Life Assessment in Skin Tag Patients
2. Sumatera Medical Journal, ISSN : 2622-9234, ISSN (Online) : 2622-1357,
Vol.1, No.1, 2018 , Quality of Life in Vitiligo Patients at H. Adam Malik
General Hospital Medan, Indonesia
3. International Journal of ChemTech Research, ISSN : 0974-4290,
ISSN(Online) : 2455-9555, Vol. 11, No. 8, 2018, Association Between
Intraurine Device Usage With Vulvovaginal Candidiasis
4. Mol Cell Biomed Sci, P-ISSN : 2527-4384, E-ISSN : 2527-3442, Vol. 2, No. 2,
No Association Between Lipid Profiles and Acne Vulgaris.
 
Publikasi Prosiding Terindeks Scopus :
5. Stem Cell Oncology, 2018, London, Identification of HPV Types 6
and 11 in Skin Tags Using PCR.
6. IOP Conference Series: Earth and Environtment Science, 2018,
Medan, Miliariapustulosa in Post Craniotomy Patient.
Penghargaan :
1.Fellows of the Asian Academy of Dermatology and
Venereology (FAADV). 10Agustus 2017.
2.Fellow of the Indonesian Society of Dermatology
and Venereology (FINSDV). Jakarta, 10 Agustus
2017.
3.Piagam Tanda Kehormatan Satyalancana Karya
Satya X Tahun. Jakarta, 8 Agustus 2017.
4.Lokakarya Nasional Bedah Kulit di Daerah Mata
dan Daerah Lain di Muka, Medan 2009.
5.Piagam penghargaan Komando Armada RI
kawasan Barat Pangkalan Utama TNI AL I,
sekertaris kulit pengabdian masyarakat FK USU.
2015
 • IcoNap. Tittle :”Is There Correlation Between Severity of Melasma and
Quality of Life?”. Medan 2018.
•23rd Regional Conference of Dermatology 2018. “Endothelin-1 Expressions
on Seborrheic Keratosis Histopathology Variants”. Surabaya 2018.
P •Medan Dermatology & Venereology Update. Tittle :“How to Evidence
Based Practice Treatment in Dermatovenereology ”. Departemen Ilmu
E Kesehata Kulit dan Kelamin FK-USU. Medan 2018.
•Medan Dermatology & Venereology Update. Tittle :“Management of
M strechmark: Prevention and Therapy”. Departemen Ilmu Kesehata Kulit
dan Kelamin FK-USU. Medan 2018.
•1st Indonesian Anti Aging Conference. “Health and Beauty with Anti
B Aging”. Pekanbaru 2017.
•Seminar Nasional Politeknik Kesehatan Jurusan Gizi KEMENKES Medan.Title:
I “Pencegahan Penuaan Dini Melalui Pangan Fungsional” Lubuk Pakam
2016 .
C •Seminar & Workshop “Holistic Anti Aging Medicine Update” Medan 2016.
•Seminar Fakultas Kesehatan Masyarakat USU. Title:”Peranan Kolagen pada
A Kesehatan Kulit: Fokus pada Penuaan Kulit (Photoaging)”. Medan 2015.
•Seminar Ilmiah Antiaging Update 2015. Title :“Cosmetic Procedures for
R Aging Skin”. Medan 2015.
•24th Congress of the European Academy of Dermatology and Venereology.
Title: “Management of Xantelasma Palpebrarum with
A Electrodessication”. Copenhagen, Denmark 2015.
•Pertemuan Ilmiah Tahunan Ke XV PERDOSKI. Title: ”Penatalaksanaan
Nevus Pigmentosus dengan Shave Exicision”. Balikpapan 2015.
 • Pengabdian Masyarakat SCORA PEMA FK USU 2017,Desa Pekan
Kecamatan Tanjung Bringin Kabupaten Serdang Bedagi ,Tahun
2017.
P • Bakti Sosial Koperasi Pengembangan USU dan FK USU di Desa
sinkuang, Desa Sukamakmur, dan Desa Manuncang, Kabupaten
E Madina, Tahun 2017.
• Penyuluhan “Hidup Sehat dan Bahagia, Bebas Infeksi Menular
M Seksual dan HIV/AIDS” Medan, 2016.
• Bakti sosial AKBAR PEMA FK USU 2016. SDN 060969. Belawan.
B • Baksos dalam rangkaian acara peringatan 50 tahun PERDOSKI
INDONESIA. “Remaja Sehat dan Bahagia, Bebas Infeksi Menular
I Seksual dan HIV-AIDS”. Medan 2016.
• Pengabdian Masyarakat Pemeriksaan Kesehatan Gratis
C memperingati HUT Kabupaten Mandailing Natal SUMUT ke 17.
Tahun 2016.
A • Pengabdian masyarakat AKBAR FK-USU 2016. “Satukan Hati,
Siapkan Diri, Mari Mengabdi, Sehatkan Negeri”. Universitas
R Sumatera Utara.
• Pengabdian masyarakat SCORA PEMA FK-USU 2016. Man Lubuk
A Pakam. 24 Januari 2016.
• Pengabdian masyarakat PEMA AKBAR FK-USU 2015 “Mengabdi
Setulus Hati, Berbagi Sepenuh Jiwa”, Pantai Cermin, Desa Lubuk
Saban. 21-22 November 2015.
• Pengabdian masyarakat FK-USU pada Kegiatan Bhakti Sosial
Kesehatan di Kabupaten Deli Serdang dan Serdang Bedagai , 16
 • Pertemuan Ilmiah Tahunan Ke XV PERDOSKI. Title : “Keratosis Seboroik tipe
Irritated”. Balikpapan 2015.
• Pertemuan Ilmiah Tahunan Ke XV PERDOSKI. Title : “Rosasea Papulopustular yang di
Terapi dengan Niasiamid Topikal dan Doksisiklin Oral”. Balikpapan 2015.

P • Pertemuan Ilmiah Tahunan Ke XV PERDOSKI. Title :”Cutis V ericitis Gyrata

Sekunder pada Pasien dengan Neurofibroma tipe-1”. Balikpapan 2015.
• Pertemuan Ilmiah Tahunan Ke XV PERDOSKI.Title : ”Perbandingan Penyembuhan
E Luka pada Empat Nevus Pigmentosus dari Seorang Pasien dengan Tatalaksana yang
Berbeda”. Balikpapan 2015.

M
• Pertemuan Ilmiah Tahunan Ke XV PERDOSKI Title : ”Kista Epidermal yang
Disangkakan Steatocystoma Simplex pada Labia Mayora”. Balikpapan 2015.
• Pertemuan Ilmiah Tahunan Ke XV PERDOSKI.Title :”Pola Penyakit Kulit dan Kelamin
B Pada Geriatri di Poliklinik Kulit dan Kelamin RSUP.H.Adam Malik Medan 2013-
2014”.Balikpapan 2015.
• Medical Update 2015 for General Practitioners. Title : “Antioksidan dalam
I dermatologi: fokus pada peran superoxide dismutase dan astaxanthin”. Medan 2015.
• Kongres Nasional XIV PERDOSKI. Title: “Granuloma Piogenikum : Suatu Laporan
C Kasus”. Bandung 2014.
• Kongres Nasional XIV PERDOSKI. Title: “Keratosis Seboroik Tipe Irritated : Suatu
Laporan Kasus”. Bandung 2014.
A • Seminar Departemen Ilmu Kesehatan THT-KL FK-USU/R.S.U.P.H ADAM MALIK
“Radiotheraphy in Management of Stenotic Nostril Caused by Keloid” 2014.

R • 12th Asia-p asific environmental and occupational dermatology symposium (APEODS) in

conjunction with 13th Annual scientific meeting of Indonesia society of dermatology and
venereology (PIT-PERDOSKI). Title : “Update in Management of Keloid”. Yogyakarta
A 2013.
• 12th Asia-pasific environmental and occupational dermatology symposium (APEODS) in
conjunction with 13th Annual scientific meeting of Indonesia society of dermatology and
venereology (PIT-PERDOSKI).Title: “A retrospective study of keloid in
dermatovenereology outpatient clinic H. Adam malik General Hospital Medan”.
Yogyakarta, 2013 .
 • 12th Asia-pasific environmental and occupational dermatology symposium
(APEODS) in conjunction with 13th Annual scientific meeting of Indonesia society of
dermatology and venereology (PIT-PERDOSKI). Title: “Secondary Wound Healing in
Chronic Ulcus”. Yogyakarta, 2013 .
P • 12th Asia-pasific environmental and occupational dermatology symposium
(APEODS) in conjunction with 13th Annual scientific meeting of Indonesia society of

E dermatology and venereology (PIT-PERDOSKI). Title: “Management of Multiple

Corns : A Case Report”. Yogyakarta, 2013 .
• Seminar Nasional Pemantapan Complimentari Alternative Medicine (CAM) dalam
M Pelayanan Kesehatan. IDI-PDAI-PDPKT. Medan 2013.
• Talkshow Check Up Bersama Prodia. Title : “Penyakit Menular Seksual”. Radio
B Laffame. Medan 2013.
• Seminar Ci Lets Working Together for Pain Relief pada KONGRES NASIONAL PNI
2012
I • Kongres Nasional PM 2012 Title: “Herpetic Pain and It’s Problem in Management
C: Lets Working Together for Pan Relief”. Medan 2012.
C • Kongres Nasional XIII Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia
Title: Menghilangkan Tattoo dengan Tindakan Dermabrasi dan Shaving. Manado
A 2011.
• Seminar Bagi Pelajar SMP dan SMA SeKecamatan Medan Tuntungan “Pencegahan
dan Penanggulangan Bahaya Narkoba dan Penyakit menular Seksual, HIV/AIDS
R serta dampak Negatif Teknologi Informasi Pada Remaja” 2011
• 22nd World Congress Dermatology. Title : “Dermaroller Therapy for Post
A Varicella Scars”. Seoul 2011.
• 22nd World Congress Dermatology. Title : “Black Piedra- A Case Report”. Seoul
2011.
•Simposium dan Lokakarya Bedah Kulit “Reconstructive Surgery Rejuvenation for
Body and Face”. Title: “Dermaroller”. Medan 2011.
Instruktur : “Pelatihan Keterampilan Dasar Bedah”. Oleh Kolegium Ilmu Kesehatan
Kulit dan Kelamin. Medan 2011.
 • PIT XI PERDOSKI. Title: “Dermaroller untuk Penatalaksanaan Skar Varisela”.
Denpasar 2010.
• PIT XI PERDOSKI. Title: “Vitiligo pada Bayi”. Denpasar 2010.
• PIT XI PERDOSKI. Title: “Piedra Hitam, Suatu Laporan Kasus”. Denpasar
P 2010.
• Seminar Clinico-Dermatopathology Title: ”Update in Skin Disease
E Management”, PERDOSKI, FK-USU. Medan 2009.
• Kongres Nasional XII PERDOSKI Indonesia,Title: “Pola Penyakit Kulit dan
M Kelamin Pada Pasien Geriatrik di Poliklinik Kesehatan Kulit dan Kelamin
RSUP H. Adam Malik Medan Januari 2005 – Desember 2007”. Palembang
2008.
B • Kongres Nasional XII PERDOSKI Indonesia, Title: “Pola Penyakit Kulit dan
Kelamin dari Penderita di Instalasi rawat inap yang dikonsulkan pada
I Poliklinik Kesehatan Kulit dan Kelamin RSUP H. Adam Malik Medan tahun
2007”. Palembang 2008.
C • Kongres Nasional XII PERDOSKI Title:”Pola Tumor Kulit di Poliklinik Kulit dan
Kelamin RSUP. H. Adam Malik Medan Tahun 2007”.Palembang 2008.
A • Symposium Dermatology Update. Kongres Nasional XII PERDOSKI : “Keloid”,
PERDOSKI. Medan 2008.
R • Pertemuan Ilmiah Tahunan VIII Perhimpunan Dokter Spesialis Kulit dan
Kelamin Indonesia title: “Hubungan Kadar Imunoglobulin E Serum dengan
Derajat Klinis dan Adanya Stigma Atopi pada Penderita Dermatitis Atopik”.
A Kuta-Bali 2004.
•Pertemuan Ilmiah Tahunan VI. Title: “Penyakit Darier pada Anak”,
Yogyakarta, 2003.
• 2nd Asean Conference on Medical Science. Title: “Deformity in Leprosy” IMT-
GT, FK-USU. Medan 2002.
• Kongres Nasional X PERDOSKI Title: “Phempigoid Bullosa”, PERDOSKI.
 Overview of
Acne Vulgaris

Nelva K. Jusuf
Imam B. Putra

Department of Dermatovenereology
Medical Faculty University of Sumatera Utara
Medan-Indonesia
2019
 There is no disease that
has caused more insecurity
and feelings of inferiority
than acne
(John Y. M. Koo)

14
 OUTLINE
1. Introduction

2. Basic pathogenesis of acne vulgaris (AV)

3. Current pathogenesis of AV including

some risk factors: diet, stress and smoking
4. Diagnosis of AV
5. Therapy
6. Take home message
15
 Introduction Acne vulgaris (AV)
Acne vulgaris (AV)
 A common and chronic disorder of
 A common and chronic disorder of
pilosebaceous unit
pilosebaceous unit
 A significant challenges because of
 A significant challenges because of
its prevalence, complexity and
its prevalence, complexity and
range of clinical expression.
range of clinical expression.

Anggrenni, Simanungkalit & Jusuf (2014):

Anggrenni, Simanungkalit & Jusuf (2014):
Retrospective study of AV patients in H. Adam Malik
Retrospective study of AV patients in H. Adam Malik
General Hospital Medan in 2010-2012 :
General Hospital Medan in 2010-2012 :
Results :
Results :
• Proportion : 1,10%
• Proportion : 1,10%
• Characteristics → mostly : female, 16-20 y.o
• Characteristics → mostly : female, 16-20 y.o
high school education level, student
high school education level, student
location on the face
location on the face
severity of stage II (Pillsburry)
severity of stage II (Pillsburry) 16
disease duration 1-52 weeks
 Many factors contribute to the
pathogenesis of AV

Besides genetics and hormonal factors it is

suggested that diet, stress and smoking
may cause or exacerbate AV

Khalida & Jusuf survey in 2012 by using

questionnaire on 100 students with AV at a private
high school in Medan, found that diet (95%) and
stress (90%) affect the development of their acne
17
 The pathogenesis is multifactorial and in recent years
The pathogenesis is multifactorial and in recent years
understanding of the mechanism involved in AV
understanding of the mechanism involved in AV
has improved with time
has improved with time
Development of molecular biology, genetics and
Development of molecular biology, genetics and
immunology contributed for a significant progress in
immunology contributed for a significant progress in
studies on the pathogenesis of AV
studies on the pathogenesis of AV

Proper understanding of pathogenesis and diagnosis of AV

Proper understanding of pathogenesis and diagnosis of AV
will lead to a better management
will lead to a better management

18
There are 4 major basic pathogenetic
factor:

• ↑ sebum production
• ↑ sebum production

• Hypercornification of pilosebaceous duct

• Hypercornification of pilosebaceous duct

• Colonization of Propionibacterium acnes (P.

• Colonization of Propionibacterium acnes (P.
acnes)
acnes)

• Production of inflammation
• Production of inflammation

19
20
21
 Increase sebum production

Sebaceous
gland

• Regulate independent endocrine function

• Regulate independent endocrine function
of the skin
of the skin

• Important role as active participant in

• Important role as active participant in
innate immunity of skin
innate immunity of skin

• Produce neuropeptide, antimicrobial

• Produce neuropeptide, antimicrobial
peptide and pro inflammatory cytokines
peptide and pro inflammatory cytokines
Korokawa. 2009, Bhambri. 2009
22
Role of sebum in
AV

Primary and essential role in

Primary and essential role in
comedogenesis under influence
comedogenesis under influence
of hormones
of hormones

Providing the substance for P. acnes

Providing the substance for P. acnes
growth
growth

Peroxisome proliferator activated receptors

Peroxisome proliferator activated receptors
(PPAR)  regulator of sebum
(PPAR)  regulator of sebum
Thielitz & Gollnick, 2013
23
 Hypercornification of pilosebaceous duct

Cause
Cause??
Linoleic acid
Androgen Linoleic acid
Androgen defficiency
defficiency
Abnormality in the
Abnormality in the ↑ IL-1
sebaceous lipid ↑ IL-1
sebaceous lipid

Obstruction of
Accumulation pilosebaceous duct with Results in
of adherent keratin, sebum and formation of
of keratinized bacteria preceded the microcomedon
cells development of AV es
lesions
Thielitz & Gollnick, 2013
24
 Androgen

Sebocytes keratinocytes

In complex manner

Cellular
differentiatio Comedogenesis
n
Cellular
Lipogenesis
proliferation 25
Korokawa. 2009
 Bacterial influence

P. acnes by action of Toll like receptor-2 (TLR-2) → stimulate

P. acnes by action of Toll like receptor-2 (TLR-2) → stimulate
secretion of IL-6, IL-8 by follicular keratinocytes & IL-12 by makrofag →
secretion of IL-6, IL-8 by follicular keratinocytes & IL-12 by makrofag →
inflammation
inflammation

Korokawa. 2009, Bhambri. 2009

26
 Inflammation

The intrafollicullar P. acnes is ingested by neutrophyl

The intrafollicullar P. acnes is ingested by neutrophyl

Release of hydrolytic enzymes

Release of hydrolytic enzymes

Effect wall dyshesion and rupture

Effect wall dyshesion and rupture

Allows the intrafollicullar contents to escape into

Allows the intrafollicullar contents to escape into
surrounding dermis
surrounding dermis

Produce inflammation
Produce inflammation 27
Thielitz & Gollnick, 2013
Besides genetic and hormonal there are
many factors contribute AV pathogenesis

Diet
Diet

Suggested may cause

Smoking Suggested may cause Stress
Smoking or exacerbate AV Stress
or exacerbate AV

Others
Others

Khalida & Jusuf survey in 2012 by using

questionnaire on 100 students with AV at a private
high school in Medan, found that diet (95%) and
stress (90%) affect the development of their acne 28
 Diet and AV
Dietary factors have long
Dietary factors have long
been implicated
been implicated
but remains controversial
but remains controversial

Dermatology textbook in late

Dermatology textbook in late
1800s and early 1900s :
1800s and early 1900s :
recommended dietary restriction
recommended dietary restriction
as an adjunct treatment to
as an adjunct treatment to
dermatology therapy → diet-acne
dermatology therapy → diet-acne
hypothesis & subsequent dietary
hypothesis & subsequent dietary
recommendation based on
recommendation based on
observation, anecdotal evidence
observation, anecdotal evidence
and speculation
and speculation

29
 Periods of Diet – AV
Studies
1st st : Before 1960 → most studies :(+) Diet – AV association
1 : Before 1960 → most studies :(+) Diet – AV association
2ndnd: Fulton et al 1969
2 : Fulton et al 1969
Anderson 1970 chocolate studies
Anderson 1970
Diet had no correlation to AV
Diet had no correlation to AV

3rdrd : Revisit/rediscovery the potential link between diet and AV cause

3 : Revisit/rediscovery the potential link between diet and AV cause
of many factors including advances in understanding the
of many factors including advances in understanding the
pathogenesis, new epidemiologic evidence supporting and a
pathogenesis, new epidemiologic evidence supporting and a
thorough critical analysis of early studies
thorough critical analysis of early studies

30
 Currents research suggest diet
influences AV

GL : glicemic load
IGF-1 : insulin like growth factor-1
IGFBP-3 : insulin like growth factor binding protein-3
SHBG : sex hormone binding globulin
Burns J, Rietkerk W, Woolf K. Acne: The Role of Medical Nutrition Therapy.
Academy of Nutrition and Dietetics. 2013
31
32
 Panjaitan, Tala &
Panjaitan, Tala &
Jusuf (2010):
Jusuf (2010):
There were no correlation
There were no correlation
between GI and GL of food with
between GI and GL of food with
IGF-1 levels in AV patients
IGF-1 levels in AV patients
Panjaitan, Kadri & Jusuf
Panjaitan, Kadri & Jusuf
(2010)
(2010)
There was no correlation
There was no correlation
between IGF-1 levels and
between IGF-1 levels and
the degree of AV severity
the degree of AV severity
33
Despite recent evidence regarding
the influence of diet and AV

this relationship should

be additionally evaluated

34
 Stress and
AV
Traditionally the correlation of stress and AV known by
Traditionally the correlation of stress and AV known by
→ psycho-neuro-endocrinological and psychoimmunological
→ psycho-neuro-endocrinological and psychoimmunological
link
link

Possible psycho-
endocrinological and
psycho-immunological
factors influencing
the course of acne.

CNS = Central nervous system,

ACTH = Adrenocorticotropin,
TSH = Thyroid-stimulating hormone,
STH = Somatotropic hormone.
Niemeier V, Kupfer J, Gieler U. Acne vulgaris Psychosomatic
aspects.
JDDG • 1610-0379/2006/0412-1027
35
 The skin may share similar mediators analog to
The skin may share similar mediators analog to
central respons to stress (hypothalamic pituitary
central respons to stress (hypothalamic pituitary
adrenal /HPA) axis
adrenal /HPA) axis
(Zoubolis, 2004)
(Zoubolis, 2004)
Neuropeptides (CRH, melanocortin, substance P, β –
Neuropeptides (CRH, melanocortin, substance P, β –
endorphin)
endorphin)
expressed in the skin as cutaneous neurogenic factors
expressed in the skin as cutaneous neurogenic factors

 Accelerate lipogenesis in the sebaceous gland

 Accelerate lipogenesis in the sebaceous gland
 Followed by proliferation of P. acnes
 Followed by proliferation of P. acnes
 ↑ Production and release of cytokines
 ↑ Production and release of cytokines
→ contribute to the onset and/or exacerbation of acne
→ contribute to the onset and/or exacerbation of acne
inflammation (Toyoda, 2003)
inflammation (Toyoda, 2003)

36
Indicate that central or topical stress
Indicate that central or topical stress
may indeed influence the feedback
may indeed influence the feedback
regulation in the sebaceous gland
regulation in the sebaceous gland

Inducing the development of

Inducing the development of
clinical inflammation in AV
clinical inflammation in AV

37
 Smoking and
AV

Contradictory reports
Contradictory reports

Smoking- Acne Studies

 Mills (1996) : suggested nicotine (+)
antiinflammatory action in AV
 Jemec et al (2002) : smoking was not significantly had
correlation with AV
 Schaefer et al (2001) : AV was significantly higher in active
smokers vs non smokers
confirmed by Chuh (2004)

38
 Firooz et al (2005) : no association AV and smoking
 Firooz et al (2005) : no association AV and smoking
 Klaz et al (2006) : inverse correlation between the
 Klaz et al (2006) : inverse correlation between the
severity of acne and the number of
severity of acne and the number of
cigarette smoked
cigarette smoked
 Capitano (2008) : straight correlation between
 Capitano (2008) : straight correlation between
smoking habit and post pubertal acne (non
smoking habit and post pubertal acne (non
inflammatory type>>)
inflammatory type>>)

39
 The underlying pathogenesis of smoking
- AV

Suggestion :
Suggestion :
?
 Keratinocyte (+) nicotine acetylcholine receptors →
 Keratinocyte (+) nicotine acetylcholine receptors →
induce cutaneous hyperkeratinization
induce cutaneous hyperkeratinization
 Nicotine → induced microcirculation alteration →
 Nicotine → induced microcirculation alteration →
vasoconstriction and hypoxaemia
vasoconstriction and hypoxaemia
 (+) anti inflammatory effect
 (+) anti inflammatory effect
 ↑ oxidative stress and ↓ levels plasma α tocopherol
 ↑ oxidative stress and ↓ levels plasma α tocopherol
 Alteration in sebum composition
 Alteration in sebum composition
Schnefer et al. 2001, Chuh et al. 2004, Klaz et al. 2006, capitanio et al. 2009

40
Relationship between smoking and AV
Relationship between smoking and AV
remains inconsistent and the
remains inconsistent and the
underlying causal mechanism of the
underlying causal mechanism of the
these relationship need further
these relationship need further
clarification
clarification

41
 Recommendations
Recommendations

Low GL food intake

Low GL food intake

Manage the stress level

Manage the stress level

Don’t smoke
Don’t smoke

42
Conclusion for Modern views of AV pathogenesis

Zouboulis CC. New concept in acne pathogenesis.

Moderne Aspekte der Aknepathogenese. Akt Dermatol 2006. 43
Bergler-C B. The aetipathogenesis of acne vulgaris-what’s new?. International Journal of Cosmetic Science. 2014
 Diagnosis of AV

AV is usually a straightforward clinical diagnosis.

AV is usually a straightforward clinical diagnosis.

Mainly effects the face (99%), the back (60%) and chest (15%)
Mainly effects the face (99%), the back (60%) and chest (15%)
Non inflamed lesions (comedones) develop earlier than inflamed
Non inflamed lesions (comedones) develop earlier than inflamed
lesions in younger patients
lesions in younger patients
Inflammatory lesions may be superficial or deep, and many arise
Inflammatory lesions may be superficial or deep, and many arise
from noninflamed lesions
from noninflamed lesions
The superficial lesions are usually papules and pustules, and the
The superficial lesions are usually papules and pustules, and the
deep lesions are deep pustules and nodules
deep lesions are deep pustules and nodules
Deep lesions are assocciated with scarring but scarring can occur
Deep lesions are assocciated with scarring but scarring can occur
after superficial lesions in scar-prone individuals.
after superficial lesions in scar-prone individuals.
Persistent postinflammatory hyperpigmentation in pigmented skin
Persistent postinflammatory hyperpigmentation in pigmented skin
In general, laboratory workup is not indicated for patients with
In general, laboratory workup is not indicated for patients with
acne unless hyperandrogenism is suspected 44
acne unless hyperandrogenism is suspectedArcher et al, 2012
Various Clinical Features of
AV

Courtesy of Diara Skin & Genital Clinic

45
 Therapy ↑ Androgen
Follicular Hormone
• Retinoic acid
• Salicylic acid Hyper- • Spironolacton
• AHA proliferati e
on
• Retinoic acid
• Isotretinoin
• Niacinamide

Acne ↑ Sebum
Inflam- • OCP
Productio
mation Vulgaris n
Hormones

• Triamcinolone • Antibiotics:
Intralesional Erythromycin,
Injection Clindamycin,
• Oral steroid P. acnes Doxycycline,
• Niacinamide Azithromycin,
Quinolones
• Benzoyl Peroxide
• Azelaic acid
46
 INDONESIAN ACNE EXPERT MEETING (IAEM) 2015
Therapy/Grade Mild Moderate Severe
First Line      
Topical RA, SA, RA, BPO, AB AB
  BPO BPO (pregnant) BPO (pregnant)
Oral (pustule/pregnant) Doxycycline Azithromycin, Quinolones,
- Erythromycin Erythromycin (pregnant)
(pregnant)
Second Line      
Topical AA AA, SA, TAIL AA, SA, TAIL
  BPO (pregnant) BPO (pregnant) BPO (pregnant)
Oral - Other AB F: Antiandrogen
  M: Isotretinoin
Third Line      
Topical RA + BPO, AB high AA, SA, TAIL
  AB high concentration, RA + BPO (pregnant)
  concentration BPO  
Oral BPO (pregnant) BPO (pregnant) F: Isotretinoin, systemic
- Other AB steroid (acne fulminant)
Adjuvant CIE, skin care, peeling, laser and light therapy
Maintenance CIE, skin care, RA < 0,01 – 0,025%, cosmeceuticals (papulex)

RA: Retinoic acid, SA: Salicylic acid, BPO: Benzoyl Peroxide, AB: Antibiotic, AA: Azelaic acid, TAIL: triamcinolone
acetonide intralesional, KIE: Communication Information Education, F: Female, M: Male 47
 Take home message

AV pathogenesis is complex with various factors are of

AV pathogenesis is complex with various factors are of
relevance and gradually being elucidated
relevance and gradually being elucidated
Diagnosis of AV is a clinical diagnosis
Diagnosis of AV is a clinical diagnosis

An improved understanding of the pathogenesis and

An improved understanding of the pathogenesis and
diagnosis leads for rational and optimal treatment.
diagnosis leads for rational and optimal treatment.

48