Acne Flashcards
What is acne?
blockage and inflammation of the pilosebaceous unit (the hair follicle, hair shaft and sebaceous gland). It presents with lesions which can be non-inflammatory, inflammatory or a mixture
Non inflamatory lesions
Comedones
Open - blackheads
Closed - whiteheads
Inflammatory acne lesions
Papules and pustules - 5mm or less in diamteer
Deep pustules
Nodules
Pathology of acne
Altered follicular keratinocyte proliferation leading to formation of follicular plugs (comedones).
Androgen induced seborrhoea (increased sebum production) within the sebaceous follicles which usually occurs around puberty.
Proliferation of bacteria (such as Propionibacterium acnes) within sebum in hair follicles.
Inflammation of the pilosebaceous unit.
Complications of acne
Scarring - hyper or atrophic scars
Post inflam hyperpigmentation or depigmentation
Pscyjoscocial effects
History to take for acne
Duration, type and distribution of lesions
Prev treatment incl OTC + response
Exacerbating factors - menstruation, contraceptives. cosmetics, creams
Systemic features - acne fulmimans
Psychosocial impact
Family history - endocrine disorders, polycystic ovarian syndrome, acne etc
Underlying causes of acne
Drugs
hyperandrogenism - irregular periods, androgenic alopecia, hirsutism
Differnetials for acne
Rosacea
Perioral dermatitis
Folliculitis + boils
Drug induced acne
Keratosisi pilaris
Drug induced acne - which drugs?
Androgens
corticosteroids
isoniazid
ciclosporin
lithum
antiepileptics - phenytoin + carbamexapine
Vit B1, B6, B12
Dioxins - chloracne
What acne drugs are contraindicated in pregnancy?
Topical retinoids and oral tetracyclines
First line treatment mild to moderate acne
12 week course of:
topical adapalene 0.1% with benzoyl peroxide 2.5%
topical tretinoin 0.025w clindamycin
Topical benzoyl peroxide (3 or 5%) with cliindamycin (1%)
Apply once daily in evening
First line treatment mild to moderate acne
12 week course of:
topical adapalene 0.1% with benzoyl peroxide 2.5%
topical tretinoin 0.025w clindamycin
Topical benzoyl peroxide (3 or 5%) with cliindamycin (1%)
Moderate to severe acne first line
12 week course of:
tretinoin w clindamycin once daily
Topical adapalene + BP once daily or topical azelaic acid (15-20%) twice daily
+/-
Oral lymecycline 408mg or oral doxycycline 100mg once daily
Lymecycline or doxycycline replacement if allergic or cnat toilerate
Trimethoprin or macrolide eg erythromycin
Other option for acne control in women
COCP + topical
What are the problems with using contraception for acne?
Oral progesterone only or progesterone implant may exacerbate acne - ise 3rd and 4th grn COCPs
Referral with acne when
Acne fulminans - same day to on call dermatology team
Dermatology if -
-Diagnostic uncertainty
Acne conglobata
Nodulocystic ance
Mild to moderate acne doesnt respond to two complete courses of treatment
Mod to severe not responded to prev treatment incl oral antibiotic
ance with scarring or persistent pigementary changes
Causing psychological distress - potential mental health services
Acne follow up (response to oral antibiotic)
1st line treatment at 12 weeks
Treatment including oral antibiotic - completely clears - stop antibiotic, continue topical
Improved but not cleared - consider continuing for 12 more weeks
What is the treatment for severe acne resistant to topical and antibiotic therapy
Isotretinoin - retinoid oral, vit A derivative (accutane)
Why can isotretinoin be dangerous?
V strongly teratogenic
What antibiptics offered in acne are teratogenic?
Lymecycline and doxycycline
Why does acne often occur at the onset of puberty?
Increase in androgen levels
