Acne

Question 1

What’s the epidemiology of acne?

Answer 1

Most common in teenagers, onset as part of puberty and clears up towards end

Can also persist into adulthood

Question 2

What is the aetiology and pathophysiology of acnes?

Answer 2

Androgenic stimulation (why males often have it worse) of sebaceous glands near hair follicles to produce sebum - in excess; blockage of follicle; sub dermal build up of sebum; infiltration from from skin commensal P.acnes; inflammation/inflammatory infiltrate - symptoms

Risk factors: puberty, periods, smoking, diet - dairy, sugars

Question 3

What are the symptoms of acne?

Answer 3

Varying severity; located face, top of back/chest/arms

Blackheads - open comedone
Whiteheads - closed comedone
Pustules - filled with a yellowish liquid
Papules - hard, below the surface

Greasy skin

Question 4

How do you treat acne?

Answer 4

Reassurance is key - teenagers will often assume the symptoms are more obvious than they are but still important to be sensitive

Frequent washing of pillows, not touching your face, keeping your face clean, not using drying/abrasive soaps, reducing the amount of sugar in your diet, increasing water intake

Topical:

• Benzoyl peroxide face wash (decreases sebum and inhibits some of P.acnes synthesis)
• Salicylic acid
• Topical Abx - clindamycin, erythromycin - for 12wks max
• Topical retinoids - effective, and should be combined with a benzoyl peroxide face wash; photosensitivity especially in early stages of treatment; CI in pregnancy despite being topical

Oral:

• Abx - doxycycline, limecycline - 3-4/12 or more as takes time to work - reassurance is key
• Oral retinoids - isotretinoin - dermatologist prescription only, issues with mental health/suicide risk, dry skin/hair/lips/eyes, liver dysfunction (e.g. raised serum lipids), teratogen
• Women - oral contraceptive pill ie Dianette (a Co-cyprindiol based one)