Acne Flashcards
What are the type sof Acne?
Acne Vulgaris
Acne Rosacea
Who is most effected by Vulgaris and rosacea?
Acne Vulgaris peaks at 15-18yrs although many women have a delayed onset. M=F but M is more severe
Acne Rosacea peaks at 30-40yrs. F>M but M is more severe. Almost always fair skinned caucasians
Explain the pathogenesis of Acne Vulgaris?
A disease of the Pilo-sebaceous unit:
1) Keratin plugs: Increased Keratinocytes, melanin and keratin blocks up the follicle- form a plug= commodore
2) Sebum becomes more viscous and so harder to clear. More released in response to androgens
3) Bacterial overgrowth= In the case of closed comedones bacteria of the epidermis of the skin build up. These attract immune cells, they attack the bacterial cells. Combination of immune cells and bacterial cells= pus=white heads
What bacteria is most responsible for inflammation in acne vulgaris?
Propionobacterium acnes
Explain the formation of whiteheads, blackheads and papules/pustules/cysts/scars etc
White heads - Closed Comedones, aka the skin has closed over the comedone. No erythema
Black head - Open comedone, aka the plug is so big the skin cant close and its visible. (Black because of melanin not dirt)
Papules/pustules/cysts/nodules - due to bacterial inflammation
Scars form after inflammation, especially if the spots are picked or popped
What anti-biotics are used for Acne Vulgaris?
Topically
- Erythromycin
- Tetracyclines
- Clindamycin
Non-topical:
- Erythromycin
- Tetracyclines
Pros and cons of isotretinoin?
- Best treatment available for stubborn/severe acne
- Permanently cures 60-70% of Acne Vulgaris Patients
- Easy to take (swallowed 1/day with a main meal)
Highly teratogenic (+1 month after stopping)
Expensive
Causes severe dry skin
Describe the pathogenesis of Acne Rosacea?
Chronic inflammation of the PSU (Pilo-sebaceous unit) and cutaneous vasculature.
Not associated with seborrhoea
Unlike Vulgaris, rosacea lacks comodones
What are the subtypes of Rosacea?
- Erythemato-telangectasic Rosacea
- Papulo-pustular Rosacea
- Phymatous rosacea (Big red swollen nose, mainly men)
- Ocular rosacea
Generally they overlap & they’re mostly treated the same
characters of ocular rosacea
-Pain/ dryness/ tiredness/ oedema/ tearing/ chalazia/ corneal damage
N.B chalazia= benign lump inside the upper or lower eyelid
How is does rosacea look?
Ace of clubs distribution
Rarely appears off face
Many patients get pronounced flushing on alcohol, hot drinks, emotion and spicy foods
Quick list of rosacea treatments
Avoid vasodilators
Topical:
- Anti-biotics: metronidazole
- Azeleic Acid
- Ivermectin
- Brimonidine
Non-topical:
- Anti-biotics: tetracycline
- Isotretinoin
- Light based therapies
Surgery for rhinophymas
How is isotretinoin different for rosacea?
Its used in smaller doses as rosacea patients already suffer from dry skin
It doesn’t cure it so needs to be kept on long-term
what subtypes of rosacea have special treatments?
Erythemato-telangectasic Rosacea is best treated with light therapies
How does azeleic acid work?
It kills acne bacteria and inhibits keratin production
Used for Acne Rosacea
How does brimonidine work?
Causes vasconstriction thus reducing the redness of rosacea.
Its used when someone has a night out or important event they want to minimise their rosacea for, not an everyday treatment
Different subtypes of acne vulgarisms
Mild -Non-inflammatory -<20 comedones <15 inflammatory lesions -No scarring
Moderate
- Inflammatory
- <100 comedones
- comedones can be papulular or pustular
- <50 inflammatory lesions
Severe -Scarring ->100 comedones >50 inflammatory lesions -Nodularcystic lesions
Aetiology for acne vulgaris
- Genetic: leads to hyperkeratosis
- Hormones: androgens : leads to hyperkeratosis
- Polycystic ovarian syndrome: XS androgens
- Stress: cortisol: release of sebum
- Products which block pores
- Wearing a headband
- XS washing of face
Treatment depending on acne
Mild acne: topical treatment e.g. benzoyl peroxide/ salicylic acid
Moderate: Antibiotics e.g. doxycycline/ tetracycline and spironolactone
Severe: Isotretinoin= vitamin A derivative which Impacts on sebum secretion
Or OCP and anti-anxiety meds
What to use to treat acne scars
- Tretinoin creams ( topical retinoid): helps unstick comedones
- Microabrasions
- Injectable fillers
- Laser treatments can prevent proliferation of epidermal tissue
What Is acne fulminans manifestations
- Nodular and suppurative acne
- Fever
- Arythalgia
- Myalgia
- Hepatosplenomegaly
Which drugs are associated with drug induced acne
- corticosteroids
- anabolic steroids
- phenytoin
- lithium
What is acne excroie
Term used to refer to papules and comedones which have been neurotically excortiated leaving crusts/scars
Phymatous rosacea
- Enlargement of sebaceous glands
- Pores become more evident
- Skin becomes smoother and more swollen
- Lumpy surface
