Acne Flashcards

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1
Q

What causes acne vulgaris

A

Chronic inflammation in polo-sebaceous units (contain hair follicles and sebaceous glands)
Kertatinocytes / increased sebum stick together leading to blocked follicles = COMEDONES
Propionibacterium acnes builds up in comedones
Hormonal - increased androgen

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2
Q

What are the symptoms of acne vulgaris

A

Non-inflammatory = mild
- Comedones due to dilated sebaceous follicle
- Causes white head (closed comedones) and black head (open)
<30 lesion

Inflammatory = mod-severe
Macules  
Papules
Pustules
Cysts 
<30-125 lesion

Severe
Hypertrophic scarring
>125 lesion

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3
Q

Where is affected by acne vulgaris

A

Pilo-sebaceous unit of face / chest + back

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4
Q

Who is affected by acne vulgarisms / RF

A

15-18 y/o
Common in puberty as increased sex hormones increase sebaceous glands production of sebum (why anti-androgen helps)
Males have it more severe
FH
PCOS = known cause
Diet / Stress = very little affect
Can get steroid induced which is usually monomorphic pustules

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5
Q

What is Acne Rosacea

A

Chronic inflammation

Unknown aetiology

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6
Q

Where does acne rosacea present

A
Ace of club distribution over face 
Non-facial sites
Flushing - emotion / spice / alcohol
Later develop persistent erythema with papule and pustules
Tenagiectasia
NO COMEDONE
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7
Q

Who is affected by acne rosacea

A

30-50 y/o
F>M
M more severe
More common in fair skinned / sensitive skin

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8
Q

What does ocular involvement cause

A

Plebharitis

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9
Q

What exacerbates

A

Sunlight
Alcohol
Spice
Emotion

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10
Q

How do you treat acne rosacea

A
Ax
Topical brimonidine 
Roacccutane for severe
Regular high factor sun screen
Laser Rx of telangiectasia = most effective
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11
Q

What Ax

A

Topical metronidazole if mild

Oral oxytetracycline if more severe

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12
Q

What is topical brimonidine used for

A

Prominent flushingn

No telangiectasia

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13
Q

What do you do if failure of maanegemnt

A

Refer to derm if think rhinopehyma (severe form)

If need roaccutane (isotretinon)

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14
Q

What is topical treatment / 1st line for acne vulcaris for mild

A
Asses anxiety and depression 
Treatment needs to be continued for 6 weeks to see effect 
Topical benzyl peroxide if mild 
Topical retinoid if mild 
May be in combination 
Topical Ax - clindamycin
 \+ benzyl peroxide if mild
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15
Q

What is non topical Rx for mod-severe

A

Oral Ax - tetracycline / doxycycline
Anti-androgen in female - COCP as alternative to Ax
Oral retinoid - Isotretinon

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16
Q

What Ax and why

A

Used to control bacteria
Tetracycline
Doxycycline
Use for 3 months

17
Q

What should always be prescribed with Ax

A

Topical retinoid - benzyl peroxideto prevent resistant

18
Q

What Ax if pregnancy

A

Erythromycin

19
Q

What is isotretinonin

A

Oral retinoid used in severe
Reduces sebum, inflammation and bacterial growth
Only prescribed by dermatology

20
Q

What are complications

A
Highly teratogenic so requires contraception if female as vit A
Dry skin / lipids and mouth = most common
Photosensitivity 
Raised triglyceride 
Abnormal LFT
Hair loss
Nose bleeds
Visual disturbance 
Low mood - screen prior to Rx 
Intra-cranial hypoertension
SJS / TENS = rare
21
Q

What do you require if female

A

Contraception x2
Pregnancy test monthly and 5 weeks post Rx
Avoid pregnancy for 2-3 years after

22
Q

What can you not combine roaccutane with

A

Tetracycline due to risk of hypertension

23
Q

Complication of acne rosecea

A

Rhinophyma

  • Hypertrophy of pilosebaceous gland of noce
  • Leads to an enlarged red bulbous nose
24
Q

What are complications of acne vulcaris

A

Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological

25
Q

When do you refer for oral retinoid

A

Severe acne
Moderate acne starting to scar or significant hyperpigmentation
Associated psychological

26
Q

What SE of Ax

A

Photosensitivity

IIH

27
Q

What do you have to make sure before COCP

A

No CI - VTE / smoker / bP