ACNE Flashcards
What is the underlying pathology in acne?
Chronic inflammation of the pilosebaceous unit, which comprises a hair follicle surrounded by a sebaceous gland. The follicle opening is blocked which leads to inflammation.
What are the causes of acne?
Increased sebum excretion
Pilosebaceous duct hyperkeratosis
Colonization by P. acnes
Inflammatory mediators
What is the difference between a whitehead and a blackhead?
A blackhead is an open comedo, where the enlarged follicle opening is open through the epidermis. A whitehead is a closed comedo where the enlargement of the follicle opening happens fully under the epidermis.
Other than open and closed comedones (blackheads and whiteheads), what other types of skin lesions are associated with acne?
Papules
Pustules
Nodules
Cysts
What are the three types of scar associated with acne?
Ice pick
Keloid
Hyperpigmentation
Where do keloid scars normally form?
Around the neck and upper chest
What are the risk factors for developing acne?
Anything that increases androgen secretion will lead to increased sebum excretion: Puberty Menstruation Polycystic ovary syndrome, Congenital adrenal hyperplasia Androgen-secreting tumors
How do we classify severity with regard to acne?
Mild - less than 15 inflammatory lesions, no scars
Moderate - more than 15 inflammatory lesions, no scars
Severe - nodules/cysts or scars
What are the management options for mild acne?
Topical benzoyl peroxide
Topical antibiotics
Topical retinoids
What are the management options for moderate acne?
Topical antibiotics/retinoids
Antibiotic/benzoyl peroxide combinations
Oral antibiotics
Anti-androgens (if female patient)
What oral antibiotics might be used to treat someone with moderation acne?
Oxytetracycline
Doxycycline
Erythromycin
What is the name of the anti-androgen compound used to treat moderate acne in female patients?
Cyproterone acetate
What are the management options for someone with severe acne?
They should be referred to see a dermatologist
Oral retinoic acid - Roaccutane (isotretinoin)
What are the side effects of roaccutane?
Teratogenic - girls should be offered oral contraceptive along with roaccutane
Frequent cracked lips, dry skin, nose bleeds
Alopecia
Liver problems
Increased lipids
Skin sensitivity to UV
Depression and suicide
What are the features of rosacea?
Usually happens in middle aged people Flushing Erythema Telangiectasia Papules Pustules - Acne (papulopustular) rosacea Lymphoedema Rhinophyma Blepharitis (chronic inflammation of the eyelid)
