Acne

Question 1

Rough treatments for mild, moderate and severe?

Answer 1

Mild - topical
Moderate - antibiotics
Severe - isotretinoin

Question 2

Acne pathogenesis?

Answer 2

Dermal inflammation: increased sebum prodcution and poral occlusion
Reduced sex-hormone binding globulin
In females: androgenic hormone imbalance related to sebum production (more peripheral conversion) (males - no evidence of too much testosterone)

Question 3

Secondary infection by?

Answer 3

Acne bacteria: Propionibacterium acnes

S. epidermis

Question 4

Mechanisms of duct occlusion?

Answer 4

Premenstrual/cosmetic/ductal hypercomification

Question 5

Any relationship between number of bacteria and acne severity?
What about sebum concentration?

Answer 5

No

Yes, and ductal occlusion

Question 6

Most severe acne?

Answer 6

Acne conglobala?

Question 7

Why might weight loss and stress reduction be useful?

Answer 7

• Less sweat

- Less cortisol

Question 8

Occupation relevance?

Answer 8

If steam/oil in environment

Question 9

Ice pick scarring?

Answer 9

Atrophic

Question 10

Features of acne rosacea?

Answer 10

Normal sebum production
No comedones
Recurrent flushing -> telangectasia
Ocular inflammation possible

Question 11

Predisposing factors to rosacea?

Answer 11

Fair skin

?Dermodex mite in hair follicles

Question 12

Management of acne rosacea

Answer 12

Topical metranidazole and ivamectin (antifungal) for spots
Avoidance of triggers for flushing (spicy food, alcohol, caffeine, weather, UV etc)

?Experimental treatment: thalidomide

Question 13

Mechanism of action of adaplolene?

Answer 13

Anti-comedonal

Question 14

Things to note re: oral abx in acne

Answer 14

Erythromycin or tetracycline (doxy/lima)
6-8 weeks to work
Use with topical therapy.
Minimum of 4 months, 6 months preferred before referral

Question 15

Side effects of tetracyclines?

Answer 15

GI upset, thrush, photosensitivity

Question 16

Notes re: OCP compared to antibiotics

Answer 16

As effective

Takes longer to work

Question 17

Monocycline - adverse effect??

Answer 17

SLE development

Question 18

How long does roacutane take to work?

MOA?

Answer 18

3-4 months

Reduces sebum production

Question 19

Systemically unwell with acne?

Answer 19

Acne fulminans

Question 20

Co-prescription of tetracyclines and roacutane?

Answer 20

NO!! Benign intracranial hypertension risk

Question 21

MoA benozyl peroxide?

Answer 21

Keratolytic (reduces duct occlusion and comedones)

Question 22

Topical retinoids in pregnancy?

Answer 22

NO!