Acne

Question 1

Describe acne vulgaris

Answer 1

Disorder of pilosebaceous follicles in the face and upper trunk

Question 2

Pathophysiology

Answer 2

1: Higher than normal sebum production (due to androgens)
2: Excessive deposition of keratin (-> comedone formation)
3: Colonisation of the follicle by Propionibacterium acnes
4: Local release of pro inflammation.
These all contribute to blocked pilosebaceous follicles. Acute inflammation through chronic acne can cause scarring of the skin.

Question 3

Clinical presentation

Answer 3

Creasy skin with comedones (blackheads), papule and pustules
Presents just after puberty
Face 99%
Back 60%

Question 4

Clinical presentation of nodulocystic acne

Answer 4

Severe with cysts

Question 5

Aetiology

Answer 5

Some genetic link. Onset of puberty brings hormonal changes (increase in androgens). Infection by Propionibacterium acnes also contributes. Diet has some unclear effect. Also worsened by stress.

Question 6

Epidemiology

Answer 6

Almost every teenager

Moderate-severe in about 20% of people

Question 7

Treatment

Answer 7

Usually self limiting. Teenagers very sensitive however.
First line: Topical agents such as keratolytics (salicylic acid), benzoyl peroxide
Second line: Low dose oral tetracycline (doxycycline)
Third line: Topical retinoid (tretinoin)

Question 8

First line treatment

Answer 8

Topical agents such as keratolytics (salicylic acid), benzoyl peroxide

Question 9

Second line treatment

Answer 9

Low dose oral tetracycline (doxycycline/lymecycline)

Question 10

Third line treatment

Answer 10

Topical retinoid (tretinoin)

Question 11

Complications

Answer 11

Scarring, psychosocial factors

Recurrence

Question 12

Complications of Retinoid (treatment)

Answer 12

Very teratogenic, adverse effect from sunlight.