Acne Flashcards
describe the pathophysiology of acne
narrow hair follicles become plugged with hair, sebum and keratinocytes
plugged follicle allows colonisation + proliferation of bacteria
– comedones, pustules and dermal inflammation
what bacteria is involved in acne
propionibacterium acnes (anaerobic)
what are closed comedones
white heads
what are open comedones
black heads
what is responsible for increased sebum production
androgens
typical areas affected by acne
face, back chest
- areas rich with sebaceous glands
mild acne criteria
scattered papule + pustules
moderate acne criteria
numerous papule, pustules + mild atrophic scarring
severe acne criteria
cysts, nodules and significant scarring
types of acne scarring
atrophic - shallow or ice-pick
hypertrophic / keloid
treatment pathway for acne
- single topical treatment only
- benzoyl peroxide
- topical retinoid e.g. tretinoin, adapalene - combination topical therapy
- add topical antibiotic e.g. clindamycin
- or combine benzoyl peroxide + topical retinoid - oral antibiotic e.g. tetracycline
- moderate acne / high scarring risk
- use in combo with benzoyl peroxide / topical retinoid - Oral isotretinoin
- severe acne if oral antibiotics have been ineffective
what else can be used in combination with topical agents in females
combined oral contraceptives
- dianette : anti-androgren properties
mechanism of action benzoyl peroxide
peeling agent that is antibacterial, anti-inflammatory and anti-comedonal
mechanism of action topical retinoid
reduced follicular hyperkeratinisation - anti-comedonal
mechanism of action oral isotretinion
reduced sebum production
side effects of oral isotretinoin
dry skin + lips teratogenic depression nose bleeds photosensitivity
side effects of oral tetracyclines
GI upset
photosensitivity
angioedema
side effects of topical retinoids
stinging, irritation, erythema + peeling
what type of contraceptive may exacerbate acne
progesterone rich/progesterone only pills
what hormones are in dianette
cyproterone acetate + oestrogen
indications for roaccutane (oral isotretinoin)
nodulo-cystic acne inadequate response to therapy / relapse after adequate antibiotic therapy significant scarring post inflammatory hyperpigmentation severe psychological impairment
features of acne rosacea
papules, pustules + erythema on nose, chin, cheeks + forehead NO comedones Often telangectasia Flushing Rhinophyma - tissue hypertrophy on nose
who is most affected by acne rosacea
females 30-40s
exacerbating factors in acne rosacea
sudden temperature change
alcohol
spicy food
treatment for acne rosacea
mild: topical metronidazole
severe: oral tetracycline
