Acne

Question 1

What type of bacteria grows in the pillosebaceous unit which causes acne?

Answer 1

Propiombacterium acnes

Question 2

Describe the pathophysiology of a sport formation.

Answer 2

In the pilosebaceous unit, Hyperkeratosis results in build up of corneocytes
Androgens stimulate sebum secretion
This causes accumulation of corneocytes and sebum.
Propiumbacterium acne grows and there is inflammatory cytokines infiltration = inflammation
This continue to develop causing marked inflammation and spot formation

Question 3

What is the term for a black head?

Answer 3

Comedone

Question 4

When a comedone becomes infected and fills with pus what does this result in?

Answer 4

A pustule

Question 5

What increases you risk of developing acne / severity of acne?

Answer 5

Caucasian males
XXY genotype
Polycystic ovarian syndrome
Hyper androgenism
Hypercortisolism

Question 6

What are the differences in the presentation between mild, moderate and severe acne?

Answer 6

Mild = non inflammatory with open and closed comedones

Moderate = papules, pustules, nodules and cysts. Inflammation & comedones

Severe = permanent scaring and inflammatory pigmentation

Question 7

What are the 3 types of acne?

Answer 7

Acne fulminans
Drug induced acne
Acne excoriee

Question 8

What is the most severe type of acne?

Answer 8

Acne fulminans

Question 9

Describe the presentation of acne fulminans.

Answer 9

Abrupt onset of nodular and suppurative acne
Large cystic
Inflammation
Painful
Systemic manifestation I.e. artralgia, pyrexia, malaise, hepatosplenomegaly

Question 10

Describe the presentation of drug induced acne.

Answer 10

No comedones

Only pustules, papules, inflammation

Question 11

What drugs are associated with drug induced acne?

Answer 11

Anabolic steroids
Corticosteroids
Phenytoin
Lithium

Question 12

Describe the presentation of acne excoriee.

Answer 12

Papules and comedones are picked / excorated leaving crusted lesions that may scar

Question 13

What is the treatment for acne?

Answer 13

Topical retinoids 
Benzoyl peroxide 
Topical antibiotics 
Azelaic acid 
Antibiotic tablets 
Oral contraceptive pill
Isotretinoin tablets

Question 14

What are topical retinoids and how do they work to treat acne?

Answer 14

Derivative of vitamin A
They work on keratinisation
Reduce number of corneocytes produced

Question 15

How does benzoyl peroxide work to treat acne?

Answer 15

Anti inflammatory + anti septic

Question 16

What is used as a last resort treatment of severe acne? And what are the disadvantages?

Answer 16

Isotretinoin (tablets)

• teratogenic
• lots of side effects

Question 17

What is the prevalence of rosacea?

Answer 17

Most common in fair skinned
30s and 40s
80% diagnosed after 30yrs age

Question 18

What is the pathophysiology of acne rosacea ?

Answer 18

Damage to dermal connective tissue
Sensitivity to noxious stimuli is increased
Increased number of demodex folliculorum

Question 19

What are the 4 types of rosacea?

Answer 19

Vascular
Inflammatory
Phymatous
Occular

Question 20

How casn you differentiate between acne and rosacea?

Answer 20

In rosacea it will only occur on the face - not the chest or back like acne
Redness/ blushing also more prominent feature
No comedones in rosacea
Age of patient (majority > 30 yrs)

Question 21

What is the presentation of ocular rosacea?

Answer 21

Dryness / tired eyes
Oedema
Tearing 
Pain
Chalazia and cornea damage

Question 22

What are the treatments for rosacea?

Answer 22

Metronidazole cream or gel 
Azelaic acid cream
Ivermectin 
Tetracyclines
Surgery for rhinophymas (infiltration of the nose)