Acne Flashcards
What type of bacteria grows in the pillosebaceous unit which causes acne?
Propiombacterium acnes
Describe the pathophysiology of a sport formation.
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
What is the term for a black head?
Comedone
When a comedone becomes infected and fills with pus what does this result in?
A pustule
What increases you risk of developing acne / severity of acne?
Caucasian males XXY genotype Polycystic ovarian syndrome Hyper androgenism Hypercortisolism
What are the differences in the presentation between mild, moderate and severe acne?
Mild = non inflammatory with open and closed comedones
Moderate = papules, pustules, nodules and cysts. Inflammation & comedones
Severe = permanent scaring and inflammatory pigmentation
What are the 3 types of acne?
Acne fulminans
Drug induced acne
Acne excoriee
What is the most severe type of acne?
Acne fulminans
Describe the presentation of acne fulminans.
Abrupt onset of nodular and suppurative acne
Large cystic
Inflammation
Painful
Systemic manifestation I.e. artralgia, pyrexia, malaise, hepatosplenomegaly
Describe the presentation of drug induced acne.
No comedones
Only pustules, papules, inflammation
What drugs are associated with drug induced acne?
Anabolic steroids
Corticosteroids
Phenytoin
Lithium
Describe the presentation of acne excoriee.
Papules and comedones are picked / excorated leaving crusted lesions that may scar
What is the treatment for acne?
Topical retinoids Benzoyl peroxide Topical antibiotics Azelaic acid Antibiotic tablets Oral contraceptive pill Isotretinoin tablets
What are topical retinoids and how do they work to treat acne?
Derivative of vitamin A
They work on keratinisation
Reduce number of corneocytes produced
How does benzoyl peroxide work to treat acne?
Anti inflammatory + anti septic
What is used as a last resort treatment of severe acne? And what are the disadvantages?
Isotretinoin (tablets)
- teratogenic
- lots of side effects
What is the prevalence of rosacea?
Most common in fair skinned
30s and 40s
80% diagnosed after 30yrs age
What is the pathophysiology of acne rosacea ?
Damage to dermal connective tissue
Sensitivity to noxious stimuli is increased
Increased number of demodex folliculorum
What are the 4 types of rosacea?
Vascular
Inflammatory
Phymatous
Occular
How casn you differentiate between acne and rosacea?
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)
What is the presentation of ocular rosacea?
Dryness / tired eyes Oedema Tearing Pain Chalazia and cornea damage
What are the treatments for rosacea?
Metronidazole cream or gel Azelaic acid cream Ivermectin Tetracyclines Surgery for rhinophymas (infiltration of the nose)
