13d. Skin Health - Acne Vulgaris Flashcards
What is acne vulgaris?
Inflammatory skin condition
Excess sebum production
Follicular hyperkeratinisation of sebaceous ducts
Follicular colonisation by Cutibacterium acnes
Where does acne predominately affect?
Face
Chest
Back
Who does acne commonly affect?
Adolescents
Males
Which bacteria is implicated in acne?
Cutibacterium acnes
What types of ‘spots’ can acne present as?
Comedones (pimples)
Dilated pores with dark plugs of keratin
Open (blackheads)
Closed (whiteheads)
Dome-shaped papules
Bacterial infection causing inflammatory cysts
What are the causes/risk factors for acne?
Hormones - increased androgens
Hormone fluctuations
PCOS
Stress
Depression/anxiety
Increased corticosteroids
Insulin resistance
Hyperinsulinemia
Dairy/high GI foods
Vit D deficiency
Microbiome
Which androgens are increased in acne?
Free testosterone/DHT (greater 5a-reductase activity)
DHEA
DHEAS (sulphated version of DHEA)
What can cause hormone fluctuations in acne?
Puberty
Menstruation
Pregnancy
Why can stress cause acne?
Release of CRH promotes lipogenesis (increased sebum)
Induces inflammatory cytokines
Why can depression/anxiety cause acne?
Skin and nerve cells are connected
Why can insulin resistance cause acne?
Increases proliferation of keratinocytes
Stimulates synthesis of androgens
Increases sebum production
Why can hyperinsulinemia cause acne?
Decreases SHBG = increased free testosterone
Upregulates IGF-1
Downregulates IGFBP-3
Net effect = increased androgen production
Why can dairy/high GI foods cause acne?
Increased IGF-1
Increased circulating levels of insulin
Dairy can activate mTORC1
Why can vit D deficiency cause acne?
Vit D regulates the proliferation and differentiation of keratinocytes and sebocytes
Anti-comedogenic properties
Why can the microbiome cause acne?
Patients have higher levels of bacteroides
Increased proportion of Cutibacterium acnes
