Acne

Question 1

What conditions are associated with Acne? (7)

Answer 1

Follicular occlusion Tetrad
- HS
- Folliculitis de-calvans
- Pilonidal cyst / abscess

PCOS
- Hirsuitism
- Hyperandrogenism
- T2DM
- obesity

Question 2

What general measures do you suggest to a patient with Acne? (9)

Answer 2

Daily or twice daily cleanser

Avoid comedogenic makeup / moisturisers
Minimise application of oils / makeup to acne prone skin

Avoid irritants
Avoid exfoliating / abrasive skin treatments
Avoid squeezing and picking pimples.

Stop Smoking

Low level evidence for a low GI diet

Apply an SPF50 or SPF50+, broad-spectrum, water-resistant sunscreen

Question 3

What topical treatments are available for acne? Include strengths
(6)

Answer 3

Topical retinoids:
- Tretinoin
- Adapalene
- Tazarotene
- Trifarotene

Topical antibiotics
- Benzyl-peroxide 2.5 - 10%
- Clindamycin
- Erythromycin
- Dapsone 5% or 7.5%
- Azelaic acid 10%, 15% or 20%
- Sodium sulfectamide

Clascoterone - 1% cream

Salicylic acid - 2% gel

Niacinomide - 2% gel

Question 4

Which topical treatments are safe in pregnancy?

Answer 4

Antibiotics
- erythromycin
- clindamycin
- dapsone

Retinoids (JAAD CME)
- Tretinoin
- Adapalene
- trifarotene

Salicylic acid

Nicotinomide 2% gel

NB: JAAD CME states intralesional steroids are contraindicated.

Question 5

Other than topical treatments, what other acne treatment options are available in pregnancy? (7)

Answer 5

Physical Treatments:
- Aviclear laser (1726 nm) - targets sebaceous glands
- Chemical peels: AHA (glycolic acid, lactic acid), BHA (salicylic acid)
- Microneedling
- Dermabrasion

Systemic treatments
- Oral antibiotics (clindamycin, erythromycin)
- Oral nictotinomide
- Oral steroids

Question 6

What is Clascoterone? What is the strength? (2)

Answer 6

Topical androgen receptor inhibitor

Available as a 1% cream

Question 7

What acne treatments are safe when breastfeeding?

Answer 7

Topical retionoids - presumed safe

Clascoterone 1% cream - presumed safe

Azelaic acid

Topical antibiotics

Spironolactone
- poorly excreted into breastmilk

Oral antibiotics

ILKA

Question 8

What are the clinical features of acne vulgaris? (12)

Answer 8

Comedones
- open
- closed

Papules
Pustules
Nodules

Erythema
Induration
Tenderness

PIH

Atrophic scaring
- ice pick
- box cut
- rolling

Hypertrophic scarring
Keloidal scarring