Acne

Question 1

1/Mild Acne treatment?
2/Moderate acne comodomes, NIL inflammation
3/Moderate acne comodomes + Inflammation
4/Moderate to severe + comodomes + inflammation
5/Severe acne

Answer 1

1/ BPO 
2/ BPO + Topical Retinoid (Epiduo) 
3/ Topical Retinoid + Topical Antibiotic (Duac), if improves keep on BPO or TR 
4/ BPO + Topical R + PO Antibiotic 
5/ Refer for Isotretinoin

Question 2

1/ Mechanism of Action of Oral Isotretinoin

2/ Side effects

Answer 2

1/Decreases sebum secretion
2/Side effects
>Teratogenic, “pregnancy should be avoided during treatment and for at least 1 month after stopping treatment” [Ref AMH]
>Delayed wound healing
>Depression: Studies have not proven it causes depression

Question 3

1/ What is the approach to mx of acne?

2/What is the general treatment of acne?

Answer 3

1/Comedolysis: unblock the pores with benzoyl peroxide or retinoic acid
Decrease bacteria in the sebum (w abx)
Dec sebaceous gland activity: with estrogens, spirnolactone, cyoroterone acetate, isotrretinoin( teratogenic)

2/General Skin care, don’t pick/scrub 
Moisturiser, light, oil free
Sun protection 
Remove makeup 
Treatment can take several weeks 6-8 weeks

Question 4

Triggers

Answer 4

Diet - increase GI foods and dairy 
Bodybuilders who take creatine, protein powders
Steroids 
OCP
Mirena/Depo / Implanon

Question 5

Pathophysiology of acne:

Answer 5

increase androgen -> increase sebum production -> blockage of sebaceous glands -> (whiteheads + blackheads) -> secondary bacterial infection (Propinobacterium) -> proteases -> inflammation.

Murtagh’s and EtG

Question 6

Which topical abx can be used in pregnancy?

Which medication should be avoided in pregnancy and breastfeeding?

Answer 6

1/ clindamycin

2/ avoid topical retinoids = teratogenic