Acne Flashcards
What must be present for a diagnosis of acne to be made?
Acne affects areas of the body with a high density of pilosebaceous glands such as the face, chest and back. Clinical features vary widely depending on severity and the person affected.
Comedones must be present for a diagnosis of acne to be made — if not present other diagnoses should be considered.
Suspect acne in those presenting with…
Non-inflammatory lesions (comedones) which may be open (blackheads) or closed (whiteheads).
Inflammatory lesions such as:
Papules and pustules – superficial raised lesions (less than 5 mm in diameter).
Nodules or cysts (larger than 5mm in diameter) – deeper, palpable lesions which are often painful and may be fluctuant. In very severe acne nodules may track together and form sinuses (acne conglobata).
Scarring — atropic/ice pick or hypertrophic/keloid scars may be seen.
Pigmentation — post-inflammatory depigmentation or hyperpigmentation may be present.
Seborrhoea — commonly present.
Papules and pustules – superficial raised lesions (less than …mm in diameter).
Papules and pustules – superficial raised lesions (less than 5 mm in diameter).
Nodules or cysts (larger than … in diameter) – deeper, palpable lesions which are often painful and may be fluctuant. In very severe acne nodules may track together and form sinuses (acne conglobata).
Nodules or cysts (larger than 5mm in diameter) – deeper, palpable lesions which are often painful and may be fluctuant. In very severe acne nodules may track together and form sinuses (acne conglobata).
Acne severity - mild, moderate, severe
Mild acne — predominantly non-inflamed lesions (open and closed comedones) with few inflammatory lesions.
Moderate acne — more widespread with an increased number of inflammatory papules and pustules.
Severe acne — widespread inflammatory papules, pustules and nodules or cysts. Scarring may be present.
Hyperandrogenism - history taking, ask about …
May present with irregular periods, androgenic alopecia or hirsutism in women. Also acne
Mild to moderate acne treatment options - 12 week course of…
Offer a 12-week course of one of the following first-line options to be applied once daily in the evening:
A fixed combination of topical adapalene with topical benzoyl peroxide (0.1% or 0.3% adapalene with 2.5% benzoyl peroxide).
A fixed combination of topical tretinoin with topical clindamycin (0.025% tretinoin with 1% clindamycin).
A fixed combination of topical benzoyl peroxide with topical clindamycin (3% or 5% benzoyl peroxide with 1% clindamycin).
For people with moderate to severe acne:
Offer a 12-week course of one of the following first-line options:
A fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily in the evening.
A fixed combination of topical tretinoin with topical clindamycin to be applied once daily in the evening.
A fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily in the evening, together with either oral lymecycline 408 mg or oral doxycycline 100 mg once daily.
Topical azelaic acid (15% or 20%) applied twice daily, with either oral lymecycline 408 mg or oral doxycycline 100 mg once daily.
What combined oral contraceptive pill may be most beneficial in moderate to severe acne?
Co-cyprindiol (Dianette®) or other ethinylestradiol/cyproterone acetate-containing products may be considered in moderate to severe acne where other treatments have failed but require careful discussion of the risks and benefits with the patient.
what is acne fulminans?
Acne fulminans is a sudden severe inflammatory reaction that precipitates deep ulcerations and erosions, sometimes with systemic effects (such as fever and arthralgia).
Conglobate acne - what is this?
Conglobate acne is a rare and severe form of acne found most often in men – it presents with extensive inflammatory papules, suppurative nodules (which may coalesce to form sinuses) and cysts on the trunk and upper limbs.
In people whose treatment includes an oral antibiotic, if their acne has cleared…
Completely cleared — consider stopping the antibiotic but continuing the topical treatment.
Improved but not completely cleared — consider continuing the oral antibiotic, alongside the topical treatment, for up to 12 more weeks.
Only continue a treatment option that includes an antibiotic (topical or oral) for more than 6 months in exceptional circumstances. Review at 3-monthly intervals, and stop the antibiotic as soon as possible.
If acne relapses after an adequate response to oral isotretinoin (prescribed under specialist care) and is currently:
Mild to moderate — offer an appropriate treatment option.
Moderate to severe — offer either:
A 12-week course of an appropriate treatment option, or
Re-referral if the person is no longer under the care of the consultant dermatologist-led team.
Isotretinoin indications
Severe acne [(such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy] (under expert supervision
Females of childbearing potential + isotretinoin
In females of childbearing potential, exclude pregnancy a few days before treatment, every month during treatment (unless there are compelling reasons to indicate that there is no risk of pregnancy), and 1 month after stopping treatment. They should be advised to use at least 1 highly effective method of contraception (i.e. a user-independent form such as an intra-uterine device or implant) or 2 complementary user-dependent forms of contraception (e.g. combined oral contraceptives and barrier method). Oral progestogen-only contraceptives are not considered effective. F
