Acne Flashcards
What is acne
Acne vulgaris = common skin disease affecting 85% of 15-24yr olds
Men more likely.
Increased levels of androgens in puberty.
Women w/ adult acne
Pilosebaceous follicles in skin are blocked
Factors leading to acne
Stress= produce more oil, block pores, hormones.
Diet= low glycaemic index diet can help. Avoid trigger foods.
Weight and exercise= reduce insulin output and stress.
Medications= corticosteroids, progesterones, testosterone, anabolic steroids, antiepileptics, lithium, azathioprine
Hormones= increased sebum production, pill, pregnancy, PCOS.
Four key processes of acne
Increased sebum production - sebaceous glands produce sebum. more sebum=acne.
Follicular hyperkeratinisation - disorder of skin cells lining hair follicle that clogs sebaceous duct.
Microbial colonisation - overgrowth of bacteria. gram +ve anaerobic rod = proinflammation, destroy tissue enzymes
Inflammatory processes - P acnes hydrolyses sebum into free fatty acids and inflammatory mediators are released. constant.
Types of comedones
Open = blackhead, block exposed to surface.
Closed = whitehead, block further from surface.
Define papule, pustule, and nodule.
Papule - small, red, inflamed bump
Pustule - papule w/ pus
Nodule/cyst - deep pustule that can become infected
Classify acne severity
Mild- comedones w/ some papules and pustules (<10)
Moderate- 10-40 papules and pustules, 10-40 widespread comedones. affect trunk. mild scarring.
Moderate/severe- 40-100 papules and pustules. <5 deep nodules. involve chest, face, back.
Severe- nodular abscess and cysts w/ widespread papules, pustules, and comedones. Extensive scarring.
Topical S2 treatment
Benzoyl peroxide - benzac. For comedonal and mild acne. Antibacterial, used w/ oral agents except oral retinoids. Start low strength. Bleach towels.
Azelaic acid - azclear. For mild acne. Less irritating than benzyoyl. Can cause hypopigmentation and photosensitisation.
Salicylic acid and tea tree oil - For mild acne. Antibacterial, anti-inflammatory.
Topical S4 treatment
Clindamycin and erythromycin. For moderate-severe acne. Add to topical retinoid.
Tretinoin and Adapalene - moderate-severe. best for comedonal acne. apply for 6 weeks, then review. Combine w/ topical/oral. Teratogenic.
Systemic S4 treatments
All for mod-severe papulo-pustular acne. All can add topical retinoid or benzoyl peroxide.
Doxycycline 1st line
Minocycline - change after 3 mths if no improvement
Erythromycin - 3-6 months for response
COC- first line is cyproterone, then drospirenone, then desogestrel.
Spironolactone- contraindicated in pregnancy. Add to COC or if COC not working.
Discuss isoretinoin
Roaccutane - for severe and cystic acne. 6-9mth course.
Cell proliferation and differentiation increased, inflammation decreased.
Avoid topical treatments and must use effective contraception.
ADR isotretinoin
Common- dry lips, eyes, nose. Flare up. Cheilitis (Inflamed lips). Sun sensitivity. Dermatitis. Facial redness, nose bleeds, lethargy, myalgia (muscle aches), joint stiffness.
Rare- paronychia (infection of nail folds), impaired night vision, rectal bleeding, dyslipidemia, headache, hair loss.
Monitoring isotretinoin
Liver functions
Lipids
Psychiatric disorders
Caution isoretinoin
Causes birth defects
do not use if pregnant
do not become pregnant
stop within 1 month before pregnancy
Isoretinoin counselling
Best taken w/ food
Report nausea, headaches, visual changes.
Use vaseline for lips, eye drops.
Avoid vitamin A supplements
Sunscreen, clothes.
Don’t wax or dermabrasion.
Referral for acne
Large comedonal part
Severe acne
Failure to respond
Cystic
Social/psycho
Scarring risk
Medication related
Uncertain diagnosis
