4th year derm

Question 1

mild, moderate + severe acne

Answer 1

mild= open and closed comodones with or without sparse inflammatory lesions (mine)

moderate= widespread non inflammatory lesions and numerous papule and pustules

severe= extensive inflammatory lesions, which may include nodules, pitting and scarring (cystic)

Question 2

treatment of mild- moderate acne?

Answer 2

1st= 12 week course of topical combination therapy:
-topical adapalene with topical benzoyl peroxide
-topical clyndamycin with benzoyl peroxide
-topical tretinoin with topical clyndamycin
-topical benzoyl peroxide monotherapy if contraindications

Question 3

treatment moderate to severe acne?

Answer 3

12 week course with one of the following:
-fixed combination of topical adapalene with topical benzoyl peroxide
-fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
-fixed combination of topical tretinoin with topical clyndamycin
-fixed combination of topical azelaic acid + either oral lymecycline or oral doxycycline

tetracyclic CI if pregnant, breastfeeding or <12 years
-erythromycin if pregnant

do not continue oral or topical antibiotics >6 months + do not use a combination of oral and topical antibiotics at the same time

after 12 week trial:
cleared= topical non antibiotics

failed to respond adequately:
mild to moderate- offer another treatment

moderate- severe:
No antibiotics used- give Abs
Antibiotics used- refer to derm for isotretinoin

other options:
-COC
-roaccutane (isotretinoin)