Achne Flashcards
- Ache vulgaris is a disorder of the pilosebaceous apparatus
- pathophysioligal factors (3)
-there is increased sebum secretion
>in achne sebaceous glands that are particularly sensitive to angrodens - when they are stimulated by these hormone they produce more sebum that normal. androgens are produced by testes, ovaries, adrenals and sebaceous glands
- >*genetic increased secretion
- poral occusion epithelium grows over the follicular surface
>can caused by genetic or environmental factors - eg cosmetics
>follicles then retain sebum that and it has increased conc of bacteria and FFAs
>rupture of these is assx with inflammation and tissue damage via free radicals and enzymes released by white cells
-bacterial propionibacterium achne
>this normal commensal colonized pilosebaceous ducts causing inflammation
-variants of acne (7)
- common type
- infantile - due to transplancental stimulation of childs sebaceous glands by materal androgens. rare, may last up to 3 years, morphology similar to common, risk factor for severe achne in adolescence
- mechanical/excoriated - when there has been xs scrubbing, picking or rubbing
-drug induced - steroids, oral contraceptives, others
-tropical - heat and humiditiy
-due to cosmetics
-achne fulminans is a rare varient in which conglobate achne is accompanied by fever, joint pains, high esr
-variants of achne assx with other conditions (4)
-assx with polycystic ovarian syndrome - increased androgen
-assx with androgen secreting tumour
-assx with congenital adrenal hyperplasia - increased androgen
-assx with virilization - increased androgens in females
Presentation of common acne
- distribution of lesions (4)
- morphology. types of lesions present (3). what may occur in severe/conglobate achne. what can follow these lesions.(1) suface character of skin (1).
- lesions usually confinsed to face, shoulders, upper chest, back
- -*types of lesions present include open comedones, closed comedones, and inflammatory lesions - papules, nodules, cysts/abscess
- severe/conglobate achne is severe achne. intercommunicating sinuses can occur between cysts containing serosanginous fluid or pus.
- following inflammatory lesions there can be depressed or hypertrophic scarring, and transient post-inflammatory hyperpigmententation
- seborrhoea may be present as surface characteristic = greasy skin
-achne vulgaris clears by mid 20s in (1)% patients. others may need Mx into their 30s
90%
-diagnosis based on (1) Ix may be needed when (1)
-clinical diagnosis. Ix may be needed if Ass condition suspected
Mx
- achne often has pschiatric complications
- local treatment for who (1) local and systematic for (1)
- local treatment for achne with commedones and papules.
- local and systemic for achne with cysts and scarring
Mx - local
-options for local Mx(5)
- regular cleansing
- benzoyl peroxide
- retinoids
- azelaic acid
- antibiotics
- benzoyl peroxide. moa(2) SE/unwanted(2) dosing(1)
- retinoids. class of drug (1) examples(4) moa(3) SEs(2) contraindications(1) dosing(1)
-benzoyl peroxide.
>antibacterial agent and reduces inflammation.
>can cause dryness and irritation. bleaches coloured fabrics.
>can be once or twice daily depending on irritation. increase strengh slowly 2.5%-10% over weeks.
-retinoids. vitamin a analogues. eg tetrinoin, isotretinoin, adapalene, tazatrotene.
>normalizes follicular keratinization, downregulates TLR2 expression, reduces serum production
>skin irritation and photosensitivity. CI is concomitant eczema
>start with low strengh. increase slowly over weeks. can use with benzoperoxide.
- azelaic acid. moa(3) dosing(2)
- topical antibiotics. examples(3) problem(1) dosing/regeme(2)
-azelaic acid
>anti-inflammatory, inhibits formation comedones by reducing proliferation of keratinocytes, bactericidal for p.acnes
>can apply twice daily but not for more than 6 months
-topical antibiotics. clindamycin, erythromycin, sulfacetamide
>problem is increasing resistance of p acnes. often to both clind and eryth
>can combine with benzoyl peroxide to reduce resistance. can combine with zinc acetate to enhance anti-inflammatory effect of ab
-Mx main systemic medications (3)
- antibiotics - tetracycline
- hormonal - cyproterone acetate, isotretinoin
mx - systemic
-tetracycline antibiotic. dosing/regeme - dose(1) dose in resistance(1) micro timing (1) macro timing (1) SE (1)
tetracycline
> dose 250-500mg/day. maintenance dose determined by clinical improvement. dose in resistance may be 1.5g/day
>micro timing- take before meals milk, antacids, calcium, iron mg salts reduce absorption
>macro timing - at least 3 months, can be up to 2 years
>few SEs. vaginal candidal/yeast infection may need to change to narrower spec erythromycin
mx - systemic
cyproterone acetate hormonal mx. moa(1) indicated in who(1) SE/problem(1) macro timing(1)
cyproterone acetate hormonal mx
- >*anti-androgen oestrogen. reduce ovarian testosterone synthesis and reduce free testosterone levels. this reduces sebum production. testosterone is an adrogen. not sure why oestrogen is in the name. maybe this is for contraception
- >*indicated only in women. with persistant achne. also acts as a contraceptive.
>problem same as with combined pill - increase risk venous thrombosis
> macro timing - course should not go on more than 3m since acne clears
mx - systemic
isotretinoin. moa(3) indication(1) dose(1) macrotiming(1)
SE/unwanted effects - in women (1) skin related (3) other (5) rare (3)
monitor(4)
isotretinoin.
>inhibits serum excretion, growth p acnes, acute inflammatory process
>indication - severe modulocystic acne that is unresponsive to other options
>dose 0.5-1mg/kg body weight
>macrotiming course only 4-6 months
>highly tetrogenic, can cause skin, eyes, lips to become dry and inflammed. can also cause nose bleeds, hyperlipidaemia, hair loss, depression, mm aches. rarer hearing loss, nighttime vision changes, abnormal liver function
>monitor before and during - pregnancy, LTFs, lipid levels, fbc
Mx - scarring
what are the treatment options for acne scarring (3)
-dermabrasion
>smooths out facial scars
-laser
-dermal fillers
