2 - acne & rosacea

Question 1

what is acne?

Answer 1

inflammatory condition of pilosebaceous unit (unit of skin containing hair follicle, sebaceous gland, arrector pili muscle - makes goosebumps)

= common 12-24yrs

Question 2

what is pathophysiology of acne?

Answer 2

1. increased androgens at puberty
2. hypercornification (build up) causes keratin plugging of sebaceous unit
3. infection with corynebacterium acnes (anaerobic bacterium)
4. keratin & sebum build up to produce comedones (white/blackheads)
5. rupture of comedones causes acute inflammation & foreign body granulomas = makes papules, pustules, cysts & nodules

Question 3

what is clinical presentation of acne?

Answer 3

• distribution reflects sebaceous gland sites so face, anterior chest, upper back
• non-inflammatory lesions (comedones) = white/blackheads
• inflammatory lesions like papules, pustules, cysts, nodules
• erythematous base = redness from accumulated blood to capillaries

Question 4

what are complications of acne?

Answer 4

• atrophic scars (ice pick scars = deep holes) (hypertrophic keloid scars = raised scar)
• skin hyperpigmentation

Question 5

what is classification of acne? (mild, moderate, severe)

Answer 5

mild = scattered comedones, papules, pustules

moderate = numerous papules, pustules & mild atrophic scarring

severe = numerous papules, pustules, severe atrophic scarring, cysts, nodules

Question 6

what is treatment of acne?

Answer 6

1st line is 12 wk course of…

1. topical adapalene w benzoyl peroxide
2. topical tretinoin w clindamycin

mild-moderate
- topical benzoyl peroxide w clindamycin

moderate-severe
- topical benzoyl peroxide w oral lymecycline/doxycycline

severe
- topical azelaic acid w oral lymecycline/doxycyline

Question 7

what is rosaecea?

Answer 7

= chronic inflammatory skin disease triggered by alcohol/stress (more in 30-40yrs females)

Question 8

what is clinical presentation of rosacea?

Answer 8

• recurrent facial flushing (visible blood vessels) - can be triggered by sunlight, alcohol, hot drinks, spicy food, stress
• rash = erythema w papules & pustule son nose, chin, cheek, forehead, sparing nasolabial folds
• also get ocular inflammation (some grittiness)

Question 9

what is management of rosacea?

Answer 9

= avoid triggers!

1st line = topical metronidazole
2nd line = topical therapies + oral antibiotics
3rd line = isotretinoin

Question 10

what is end stage rosacea? what is treatment of this?

Answer 10

telangiectasia + rhinophyma (big red bumpy nose)
= treat w laser therapy

Question 11

what is adapalene?

Answer 11

one of topical therapies for acne treatment, it’s type of retinoic acid (strong vitamin A) = they target comedone formation

• preferred retinoid

Question 12

why combine antibiotics with acne treatment?

Answer 12

to minimise resistance

Question 13

what additional pill is helpful for females w acne? (especially PCOS)

Answer 13

contraceptive pill (has to involve oestrogen too, not just progesterone only pill)

Question 14

what is isotretinoin?

Answer 14

strong drug for sever acne treatment, is very good and sometimes only need 1 course, associated w lots side effects like dryness, mood problems, need to monitor LFTs
- also teratogenic so females need good contraception

Question 15

what is lichen planus?

Answer 15

= chronic inflammatory disease (associated w Hep C)
= most common lichenoid disorder (disorders with damage to basal epidermis)

Question 16

what is presentation of lichen planus?

Answer 16

• itchy flat topped violaceous papules
• flexor surfaces
• lacy white oral lesions (inside cheek)

Question 17

what is seen on biopsy of lichen planus?

Answer 17

• irregular sawtooth acanthosis
• hypergranuloss & orthohyperkeratosis
• band-like upper dermal infiltrate of lymphocytes
• basal damage w formation of cytoid damage

Question 18

what is treatment of lichen planus?

Answer 18

topical steroids & antihistamines