Acne

Question 1

What is the pathogensis of acne vulgaris and the five pillars?

Answer 1

1- basal keratinocyte proliferation - driven by androgens
2- increased sebum production
3- propionibacterium acnes colonization
4- inflammation
5- comedones (white and black heads) blocking secretions

Question 2

How is mild acne treated?

Answer 2

topical benzoyl peroxide or a topical retinoid e.g. isotretinoin
Treatment takes up to 8 weeks to work

Question 3

How is moderate acne defined and treated?

Answer 3

It has more inflammatory lesions e.g. papules and pustules
Treated wtih:
-Topical antibiotics combined with benzoyl peroxide or topical retinoid
-Oral antibiotics can be tried e.g. doxycycline and tetracycline combined wtih benzoyl peroxide

Question 4

How is severe acne treated?

Answer 4

This is nodules, cysts and scats
Isotretinoin is the best option and has benefit in almost all patients
Side effects include teratogenic, mucosal dryness and depression

Question 5

What is acne rosacea?

Answer 5

This is a chronic relapsing remitting disorder of bleed cessels and pilosebaceous units causing acne of the face
Treated similarly to acne vulgaris

Question 6

What are the clinical features of acne vulgaris?

Answer 6

Comedones (open and closed)
Ice pick scarring
Sebhorrhoea
Follicular nodules, papules and scars

Question 7

How do you differentiate rosacea and vulgaris?

Answer 7

Patients older
ERythema and telangestasia on cheeks and forehead
History of flushing (hot drinks, spices, alcohol)

Question 8

What are the side effects of isotretinoin?

Answer 8

LFT disturbance
Photosensitvity
Teratogenic
Dry mucosal membranes/ skin
Myalgia or arthralgia
hair loss
Rare mood disturbance