ACNE Flashcards
(46 cards)
What is acne vulgaris?
A chronic inflammatory skin condition characterised by the blockage and inflammation of the pilosebaceous unit
What is the pilosebaceous unit?
The hair follicle, hair shaft and sebaceous gland
Where on the body does acne vulgaris typically affect?
Face 99%
Back 60%
Chest 15%
All areas with a high density of pilosebaceous glands
What are non-inflamed lesions known as in acne vulgaris and what are the types?
Comedones
Open - blackheads
Closed - white heads
Microcomedones - clinically invisible
What are inflamed lesions in acne vulgaris?
In severe disease what can these develop into?
Papules
Pustules
In severe disease they can develop into larger, deeper pustules, nodules or cysts
Age of onset typical for acne vulgaris ?
Over 85% are 12-24, 8% are 25-34, and 3% are 35-44
Usually resolves by the time adolescence ends
Persistent acne can last into adulthood for a small number of people
A smaller proportion may experience acne for the first time in adulthood
Rough staging for acne vulgaris?
Mild acne - predominantly non-inflamed lesions
Moderate acne - widespread with an increased number of inflammatory papules and pustules
Severe acne - widespread inflamamtory papules, pustules or nodules or cysts. Scarring may be present
What is conglobate acne?
A rare and severe form of acne
Most often found in men
Presents with extensive inflammatory papules, suppuration nodules which may coalesce to form sinuses, and cysts on the trunk and upper limbs
What is acne fulminans?
Sudden severe form of inflammatory acne that precipitates deep ulcerations and erosions
Sometimes has systemic effects - fever, arthralgia and myalgia)
Occurs after unsucceful treatment of acne conglobata
Pathogenesis of acne vulgaris?
Altered follicular keratinocyte proliferation -> formation of follicular plugs (comedones)
Androgen-induced seborrhoea within sebaceous follicles around the time of puberty
Proliferation of bacteria, such as cutibacterium acnes, within sebum in hair follicles
Inflammation of the pilosebaceous unit
Other factors that may contribute to- genetics, racial and ethnicity factors, diet, hormones
Diet and acne
May be a correlation between acne and high glycaemic index diets
Other foods inconclusively linked:
- milk and whey proteins
- dairy and meat products high in leucine
Diets with sufficient levels of the following may reduce acne lesions:
- omega 3 fatty acids
- y-linoleic acid (often found in veg oil)
Hormonal factors and acne
Females may notice increased eruptions slightly prior to the first few days of their menstrual period
Hyperandrogenism or PCOS increases risk of acne
Epidemiology of acne?
9% of people worldwide
Affects 80-90% of teenagers
More common in males during adolescence
More common in women during adulthood
Men are more likely to experience severe acne
Presentation of acne vulgaris?
Comedones - open ans closed
Papules
Pustules
Nodules
Cysts
Scarring
Depigmentation or hypderpurgmnetation
Seborrhoea
Types of scarring secondary to acne?
Ice pick - small, sharp indentations that are wider at the skin’s surface and narrow into point as they reach down into the skin
Hypertrophic - raised, thickened, wider
How does drug-induced acne present?
It will be monomorphic
For example, with steroid use, pustules are normally seen
Which drugs can cause or exacerbate acneiform eruptions?
Dioxins - chloracne
Corticosteroids
Anti-epileptic meds
Lithium
Isoniazid
Ciclosporin
Vitamins B1, B6 and B12
Anabolic steroids
Advice for acne vulgaris?
Avoid over-cleaning the skin
Use a non-alkaline synthetic detergent cleaning product twice daily
Avoid oil-based comedogenic skin care products, makeup and sunscreen
Dont pick or scratch lesions
Not enough evidence to support specific diets
Managing mild-moderate acne?
12 week course of one of he following - apply OD in evening:
- topical adapalene with topic benzoyl peroxide
- topical tretinoin with topical clindamycin
- topical benzoyl peroxide with topical clindamycin
Management of moderate-severe acne vulgaris?
12 week course of one of the following:
- topic adapalene with topic benzoyl peroxide OD in evening
- topical tretinoin with topical clindamycin OD in evening
- topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
- topical azaleic acid + either oral lymecycline or oral doxycycline
In women, COCP can be considered as an alternative to systemic antibiotics. Dianette (co-cyprindiol) is often used as it has anti-androgen effects but note it has increased risk of VTE!
Why should a topical retinoid or benzoyl peroxide always be considered-prescribed with oral antibiotics when treating acne vulgaris?
To reduce the irks of antibiotic resistance developing
Topical + oral antibiotics shold not be used in combination!
Likewise mono therapy with a topical antibiotic or oral antibiotic should not be used
Which pt with acne vulgaris should be referred to dermatology?
Acne fulminans - refer to be assessed within 24 hours!!
Pt with acne conglobate
Pt with nodulo-cystic acne
Consider:
Mild-mod acne not responded to 2 completed courses of Tx
Mod-severe acne that has not responded to Tx that included an oral antibiotic
Acne with scarring
Acne with persistent pigmentary changes
Acne causing/contributing to persisting psychological distress or mental health disorder
Complications of acne vulgaris?
Scarring
Post-inflammatory pigmentation changes
Psychological distress
Systemic comorbidities e.g. obesity, DM, hyperlipidaemia, hypertension, metabolic syndrome
How does topical benzoyl peroxide help manage acne?
Antiseptic - toxic to cutibacterium acne
