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CP2 Dermatology > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

Definition of acne vulgaris

A

An inflammatory disease of the pilosebaceous unit, characterised by comedones, papules and pustules

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2
Q

Aims of treatment of acne?

A
  • decreasing psychological morbidity

- preventing permanent scarring

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3
Q

Epidemiology of acne vulgaris?

A
  • affects 85% between 12 and 24
  • onset usually at puberty
  • adolescence M>F
  • 30% women and 1% men continue to have acne until 25y
  • may persist into 40s (10% women)
  • may develop in late 20s or 30s
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4
Q

What are some myths regarding aetiology of acne?

sounds silly but important if asked in osce

A
  • affects only teenagers
  • poor hygiene causes acne
  • chocolate and fatty foods cause acne
  • drinking lots of water improves acne
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5
Q

How does the normal pilosebaceous unit work?

A

sebaceous glands drain into hair follicle. Sebum is secreted into hair follicles and act as emollient for skin

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6
Q

What bacterium resides in the follicular duct?

A

Propionibacterium acnes

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7
Q

What is the pathogenesis causing acne?

A
  • increase in sebum excretion rate (SER)
  • abnormal follicular keratinisation and desquamation (hypercornification) leading to obstruction
  • colonisation with P. acnes
  • inflammation
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8
Q

What is seborrhoea?

A

Greasy skin

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9
Q

What causes seborrhoea?

A

end organ hypersensitivity/ decrease in sex hormone binding globule/ increase in androgens leads to an increase in the SER which leads to seborrhoea

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10
Q

What is a microcomedo?

A

a blocked pore

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11
Q

How does microcomedo occur?

A

Androgens/ FFA from sebum -> hyperkeratosis of follicle -> abnormal desquamation -> retention keratosis -> microcomedo

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12
Q

Which conditions do P. acnes bacteria thrive in?

A

sebum

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13
Q

How does inflammation occur in acne?

A

Products of P. acnes interact with host cells, causing inflammation

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14
Q

Types of non-inflammatory lesions?

A

Open and closed comedones

Build up of keratonous material

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15
Q

What are open comedones?

A

blackheads (black cos oxidation of melanin)

  • dilated orifice
  • layered with keratinous squamae
  • P. acnes
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16
Q

What are closed comedones?

A

whiteheads

  • undilated orifice
  • disordered keratinous squamae
  • P. acnes
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17
Q

Which out of open / closed comedones is more likely to become inflammed?

and why?

A

Closed as follicles can burst more easily

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18
Q 
Superficial types of inflammatory lesions?
How do they occur?
Are they superficial or deep?
How long do they take to heal?
Do they scar?
A
  • erythematous papules
  • pustules

occur when a closed comodone bursts and releases fatty acids into the area

superficial

1-2 weeks

no

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19
Q

Deep types of inflammatory lesions?

A
  • nodules
  • cysts (rarely found in acne)
  • abscesses (rare)
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20
Q

What are nodules?

How long do they take to heal?

A

Excessive inflammatory response in the surrounding dermis
Painful and take weeks-months to heal
scar

21
Q

What is acne sequelae?

A

post inflammatory changes, transient, superficial inflammatory lesions do not scar

ice pick scar/atrophic scar/ hypertrophic/keloid scar from nodules/cyst/abscess

22
Q

Factors aggravating acne

A
  • occlusive cosmetics/hair products - oily
  • heat/humidity
  • excessive/ vigorous washing
  • manipulation of lesions
  • exogenous medications e.g. OCP/ steroids
23
Q

DDx of acne vulgaris?

A
  • rosacea
  • peri-oral dermatitis
  • folliculitis
24
Q

Treatment of acne?

A

patient education and medication

25
Q

Types of medication to treat acne?

A
  • retinoids
  • antibacterials
  • antibiotics
  • hormonal
26
Q

How long should you try medication to assess efficacy?

A

minimum 6 weeks in combination except isotretinoin

27
Q

Factors affecting choice of treatment

A
  • clinical severity
  • effect of acne on QoL
  • previous treatment response
  • side effects and contraindications of treatments
28
Q

When is topical treatment indicated?
Types of topical treatment
How is it prescribed?

A
  • 1st line mild-moderate disease
  • retainoids, antibacterials, antibiotics
  • combination treatment, apply od/bd
  • limited use in sensitive skin
29
Q

How do topical antibacterials work and give some examples?

A

anti-bacterial and anti-inflammatory, comedolytic

Benzoyl peroxide - available OTC - mild-mod papulopustular acne
- Brevoxyl, PanOxyl

Azelaic acid - rarely used

30
Q

S/E of BPOs

A
  • dryness
  • irritation
  • bleaching clothes
31
Q

S/E azelaic acid

A

irritation

32
Q

Examples of topical antibiotics

A

antimicrobial and anti-inflammatory

  • erythromycin
  • clindamycin
  • benzamycin (erythromycin + BPO - more effective)
33
Q

Problems with topical antibiotics?

A
  • resistance

- limit use to 6m esp for erythromycin

34
Q

When is systemic abx indicated?

A
  • mod-severe acne
  • failure of topical treatment
  • scaring/ marked post-inflammatory hyperpigmentation
  • consider if chest/back involved
  • combine with topical agents
35
Q

Types of systemic antibiotics (think of 1st line…2nd line etc)

A

1st line: cyclines

  • lymecycline - 300mg od
  • doxycycline - 100mg od
  • tetracycline 500mg bd

2nd line: macrolides
- erythromycin 500mg bd

3rd line: trimethoprim 300mg bd

36
Q

When are cyclines CI’d and why

A
  • pregnancy and breastfeeding - teratogenic

- children < 12y - discoloration of growing teeth

37
Q

SE of erythromycin?

A

GI s/e

resistance

38
Q

What is the issue with trimethoprim?

A

not licensed for use in acne

39
Q

How can we limit resistance?

A
  • combination therapy e.g. use BPO with retanoid
  • limit duration of treatment (treat<6m)
  • avoid mixing antibiotics simultaneously e.g. use same topical and oral
  • retreat with same antibiotic (assuming all efficacy retained)
  • maintain remission with topical retinoid/ BPO
40
Q

What type of hormonal treatment can be used and when is it licensed?

A

OCP Dianette

  • variable tolerance and obvious CIs - increased risk of VTE
  • used in failure to treat with systemic treatment
41
Q

What is oral isotretinoin?

A

A systemic retinoid
Roaccutane

Must not be taken with other acne meds

42
Q

How does isotretinoin work?

A
  • reduces sebaceous gland size
  • reduces sebum production and excretion (up to 70%)
  • reduces comedogenesis
  • thereby decreases P. acnes and inflammation
43
Q

Indications of isotretinoin

A
  • severe acne
  • active acne with scarring
  • resistant disease
  • where rapid relapses on cessation of oral therapy
  • acne leading to psychological/ psychiatric disease

MUST BE under specialist supervision with regular review

44
Q

S/E of isotretinoin

A
  • dry skin, chelitis, dermatitis, dry mucosa, epitaxis, hair loss (rare)
  • teratogenicity
  • increased lipids - triglicerides which can lead to acute pancreatitis
  • deranged LFTs
  • arthralgia/myalgia
  • disruption of night vision
  • depression?
45
Q

What tests are routinely done BEFORE taking isotretinoin?

A

Pretreatment: fasting lipids, LFT, FBC, U&E, urine pregnancy test, 2 forms of contraception ladies

46
Q

What tests are done while taking isotretinoin?

A
  • U&E at 1 month
  • ## monthly pregnancy tests
47
Q

How long is isotretinoin used for?

A

4-6 months,

22-30% relapse rate

48
Q

Treatment of acne scars?

A

only once active disease has settled

  • microdermabrasion
  • dermabrasion
  • laser resurfacing (risk of hypopigmentation)
  • excision
  • intralesional steroid for keloids

CP2 Dermatology (5 decks)

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