Acne

Question 1

What is acne?

Answer 1

Inflammatory disease of the pilosebaceous follicles in the face and upper trunk. Can lead to psychological issues eg low self-esteem.

Question 2

Describe the pathophysiology of acne

Answer 2

1. At puberty, androgens increase production of sebum (oil) from sebacious glands in follicles.
2. Follicles fill with keratinocytes (keratinisation) which block them and trap the sebum - it is now a comedo.
3. This makes it hospitable for proprionobacterium acne bacteria which profilerate.
4. Comodo rupture/popping triggers and inflammatory response involving papules, pustules and nodules.

Question 3

What is a comedo?

Answer 3

A clogged hair follicle in the skin. Keratin combines with sebum (oil) to block the follicle. Can be closed by skin (whitehead) or open (blackhead).

Question 4

Give 3 risk factors for acne.

Answer 4

Adolescence
Premenstrual females
Males
Family history
Polycystic ovary disease
Heavy use of cosmetic products

Question 5

Describe the presentation of acne.

Answer 5

Greasy skin
Papules, pustules and nodules on face (99%), back (60%) and chest (15%).
Pain
Tenderness
Erythema
Scars

Question 6

What should you consider if acne is painful?

Answer 6

Nodulocystic acne - severe acne with cysts.

Question 7

Describe the investigation of acne.

Answer 7

Usually diagnosed on history and exam.
Skin lesion culture for patients that do not respond to treatment.
Check for polycystic ovary disease.

Question 8

Describe the non-pharm management of acne.

Answer 8

If severe, refer to dermatologist - risk of severe scarring

Advice and reassurance - hygiene, disspell myths

Question 9

Describe the pharmacological management of acne.

Answer 9

Topical:
1. Salicylic acid
2. Azelaic acid
3. Benzoyl peroxidase
4. Antibiotics - erythromycin, clindamycine, tetracycline
5. Combined oral contraceptive pill
Scarring -> laser resurfacing, chemical peels