Acne: Past, Present, and Future Emma Taylor, M.D Assistant Clinical Professor Dermatology and Dermatopathology, UCLA 2/24/1015 Disclosures  Cofounder, President, and CEO of Skinomics.INC Acne: A Historical Perspective  Ancient Egyptian Aku-t -boils, blains, sores, pustules, inflamed swelling  Fuchs 1840 coined-Acne Vulgaris, Acne Mentagra and Acne Rosacea  Bloch 1931 proved relationship acne to puberty Acne and the First Therapies  Ancient Egypt, Greece, and Rome used sulfur treatments  1920s: Benzoyl Peroxide introduced  1970s: Tretinoin (original Retin A), antibiotics (minocycline)  1980s: Accutane introduced – >2000 women became pregnant between 1982 and 2003, majority ending in miscarriage – 160 babies with defects born – Ipledge system established Acne Epidemiology Today  Acne affects >80% of the population  O ver 50 million people in the US, and over 150 million in the seven major markets.  It is among the top 5 most economically burdensome skin diseases in the US  Total costs predicted to exceed $3 billion 2016  However, market revenues are stagnant due to patent expirations, generic competition, lack of long term efficacy Acne Pathogenesis  Inflammation  Overgrowth Propionibacterium acnes  Increased androgens, sebum production  Abnormal differentiation of keratinocytes Acne Pathogenesis Genetic and Environmental Factors  Strong familial predisposition related to severity  Diet inconclusive-possible relation to high glycemic index  Smoking exacerbates  Hormonal influences-worsens in puberty  Medications-lithium, corticosteroids, vitamin B12  Stress Types of Acne  Comedonal  Inflammatory  Nodulocystic  Scarring Current Acne Therapies  Topicals – Benzoyl Peroxide – Retinoids – Antibiotics – Misc (, Azaleic Acid,sulfacetamide sulfur, Dapsone gel, glycolic acid, salyclic acid, natural products)  Orals – Antibiotics (doxycycline, minocycline) – Isotretinoin – Antihormonals (Spironolactone, OCPs)  Procedures – Light therapy (PDT) – Dermabrasion/Extraction/Injections