Acne Flashcards
What factors can cause acne?
Stress
Diet
Exercise and weight
Medications
Hormones
Sweat
Bacteria
Summarise the four key processes involved in acne?
Inc sebum production = controlled by androgens
Follicular hyperkeratinisation = clogs or blocks pore –> microcomedo
Microbial colonisation = skin bact overgrowth Proprionibacteria acnes in pilosebaceous duct
Inflammatory process
How does P. acnes influence inflammation?
P acnes hydrolysis sebum into free fatty acids –> release of inflammatory mediators
Seen in papule, pustule, nodule
What are the different types of comedo?
Open = blockage close to skin surface –> oxidation –> blackhead
Closed = blockage further from skin surface –> whitehead
What is a papule?
small, red, inflamed bump
What is a pustule?
small, red, inflamed bump (same as papule)
contains pus (pimple)
What is a nodule or cyst?
deep pustular lesions which if become infected will be painful
What is considered mild acne?
Comedones (non inflammatory lesions), some papules and pustules (<10)
What is considered moderate acne?
Moderate no. papules and pustules (10-40), comedones present are more widespread (10-40)
May effect trunk, mild scarring
What is moderate/severe acne?
Numerous papuples and pustules present (40-100), occasional deeper nodular inflamed lesion (up to 5)
Widespread infection - face, chest, back
What is severe acne?
nodular abscesses and cysts
What are some differential diagnoses for acne?
Rosacea = no comedones, cysts, scars, inflammatory papules, affects face, erythema, usually after 30 yrs/age
seborrheic dermatitis = greasy scales with yellow-red papules
Drug-induced acne = seen with androgens, corticosteroids, oral contraceptives, lithium, phenytoin
Bacterial folliculitis = abrupt eruption, spread with scratching or shaving, distribution variable, onset after puberty
Perioral/periorbital dermatitis = papules/pustules confined to chin, nasolabial/ocular regions, clear around border, females between 20-45
Summarise some topical drugs for acne (S2)?
What type of acne are they used in?
Benzoyl peroxide = comedonal & mild acne
Azelaic acid =mild acne
Salicylic acid (beta hydroxy acid( & tea tree oil = mild acne
Discuss the use of benzoyl peroxide in acne treatment?
Antibacterial, mildly comedolytic
Can be used with oral agents EXCEPT retinoids
Begin at lower strength, can bleach clothes/towels/etc.
Discuss the use of azeleic acid in acne treatment?
less irritating than benzoyl peroxide
May cause hypopigmentation or photosensitisation
Discuss the use of salicylic acid/tea tree oil in acne treatment?
Antibacterial
Mildly comedolytic
Anti-inflammatory
What are the topical prescription medications for acne?
*all for moderate/severe acne
Clindamycin = add to topical retinoid
Erythromycin = add to topical retinoid
Tretinoin = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen
Adapalene = treat for 6 wks, combine w/ other topical/oral treatments –> teratogen
List the systemic S4 drugs used in acne treatment
doxycycline
minocycline
erythromycin
COC = cyproterone, drospirenone, desogestrel, or gestodene
spironolactone
Elaborate on the hormonal drugs used for acne
(what line of treatment? what acne severity?)
- Moderate-severe acne, Improvement is slow = 6 months
COC = alternative to abx
Cyproterone = 1st line –> most likely to improve acne
Drospirenone = if cypro not tolerated
Desogestrel or gestodene = less androgenic, if cypro not tolerated
Discuss the use of spironolactone in acne treatment
For women, diuretic/anti-androgenic
Used if COC C/I
Taken once daily for 6 months
Can be combined w/ COC = inf efficacy
C/I in preg
When should acne treatment with minocycline be changed?
if no response after 3 months
Has more ADRs
When is erythromycin used to treat acne? How long until response?
3-6 months, can be longer until response
Last line when in comes to abx
Summarise the use of doxycycline in acne treatment
Works via anti-inflammatory action
Once daily for 6 months
How long does it take to see improvement with abx when treating acne?
4-8 weeks to see improvement
Change treatment if no response after 3 months
Good response = 3-6 months or longer
Discuss the use of isotretinoin in acne treatment
Course length = 6-9 months, prolonged remission
Potent teratogen = contraception during and 1 month after
MOA = modulates cell proliferation and differentiation, dec inflma
Avoid topical treatments
What are some ADRs for isotretinoin?
Dry lips, eyes, mucosal lining of nose
Cheilitis, sun sensitivity, myalgia
paronychia, impaired night vision
What are some counselling points for isotretinoin?
Absorbed best if take with food
Report headache, nausea, vomiting
Dry eyes, lips = parrafin for lips, lubricating eye drops
Avoid vitamin A supplements
Protect skin from sun
Avoid waxing/dermabrasions
What are some referral points for acne?
Large comedonal component
Severe acne, acne not responding to treatment after 2-3 months
severe-cystic acne
Social/psych problem
Risk of scarring
Clinical features make acne diagnosis uncertain
Med related/underlying causes of acne
Summarise some lifestyle changes for acne
cleanse gently
avoid vigorous/abrasive scrubbing
avoid toners, oil-based moisturisers
Dont squeeze pimples
Why is acne treated?
Improve complexion, reduce lesions
prevent scarring
limit disease duration
reduce psychological stress
What are some important self-care points for acne?
Gently cleanse twice a day and after exercise
Avoid irritating or oily cleansers
Do not pop, squeeze, rub, or pick acne
avoid perfumed products
keep hair clean and away from face/neck
eat regular, healthy meals
exercise on all or most of days of week
drink heaps of water
don’t smoke
