acne Flashcards
what is the aetiology of acne ?
androgens stimulate the sebaceous gland
causing sebaceous gland over - activity
associated with drugs - steroids and anticonvulsants
Dietary - dairy products and high glycaemic foods
what is the pathogenesis of acne ?
- excess sebum production
- follicular epidermal hyper proliferation with plugging of the follicle
- presence of cutibacterium acnes
- inflammation
black head vs a white head ?
black head is an open comedone
white head is a closed comedone
stages of acne ?
normal follicle
open comedone
closed comedone
papule
pustule
sign that triggers a patient to see the doctor ?
inflammation
tyoes of acne ?
white head
black head
cysts
pustules
papules
nodules
what is the grading of acne ?
mild - less than 20 comedones
moderate - 20-100 comedones
severe - more than 100 comedones
5 or more cysts, nodules
clinical manifestations of hyperandrogenism ?
acne
hirsutism
acanthosis
hair loss
irregular menses / infertility
what are the complications of acne ?
post inflammatory hyper pigmentation
scarring
targets of acne treatment ?
decrease sebum
desquamation
cutibacterium acnes
androgens
scarring
topical treatment for acne
benzoyl peroxide
Antibiotics
topical retinoids
1st choice treatment for acne
usually retinoids :
adaplene
treinoin
isotretinoin
systemic treatment for acne
AB
isotretinoin
anti-androgens - to reduce sebum production
treatment for miild papular pustular acne
topical retinoids along with topical anti microbial
adaplene + benzoyl peroxide
Isotretinoin + topical ab
moderate inflamm acne treatment
oral ab (tetracycline) or spironolactone ( anti androgen effect )
along with topical retinoids
alternative acne treatment for women with moderate acne and signs of androgenisation ?
dianette can be used and should bee reserved for moderate to severe acne
especially if there is any evidence of hyperandrogenosim
what is dianette ?
co-cyprinderol
mode of action of spironolactone ?
diuretic and has anti androgen effects
treatment of severe acne
oral isotretinoin - Roaccutane
side effects of oral isotretinoin - Roaccutane
dry skin
dry eyes
hoarse voice
chelitis - chronic inflamation of the lips
headaches
arthritis
teratogenicity
adverse psychiatric effects
when are investigations required in acne patients ?
before prescribing isotretinoin :
-liver function
-lipid profile
-pregnancy test ( teratogenic )
Signs suggesting hyperandrogenism
Signs suggesting cushing syndrome
treatment for acne scarring ?
laser
microneedling
subcision - used for valley scars
what is the presentation of infantile acne ?
site : cheeks, forehead and chin
causes of infantile acne ?
unknown
genetic
hormones - testosterone and androgens
no investigations needed
how to treat infantile acne ?
mild/moderate - usually no treatment , reassurance
severe - topical ( benzoyl peroxide or erythromycin gel )
side effects of tetracyclines
yellow staining of teeth
folliculitis declavans
scarring alopecia characterized by redness and swelling
pustules around the hair follicle
what micro organism can be isolated from pustules in folliculitis declevans
staph aureus
management for folliculitis declevans ?
oral ab
oral steroidds
oral isotretinoin
inflammatory disease of the apocrine glands …..
hidradenitis suppurativa
sites where hidradenitis supprativa is commonly found
axilla
groin
under the breast
C/P of hidradenitis supprativa
recurrent boil like nodules
abscess
sinusees
scarring
other term used to describe hidradenitis suppurativa
acne inversa
treatment for hidradenitis suppurativa ?
topical - clindamycin and benzoyl peroxide
systemic - AB for at least 3 months
Anti-androgens - Oral contraceptive pill
corticosteroids and retinoids
