Acne

Question 1

describe the pathophysiology of acne

Answer 1

narrow hair follicles become plugged with hair, sebum and keratinocytes
plugged follicle allows colonisation + proliferation of bacteria
– comedones, pustules and dermal inflammation

Question 2

what bacteria is involved in acne

Answer 2

propionibacterium acnes (anaerobic)

Question 3

what are closed comedones

Answer 3

white heads

Question 4

what are open comedones

Answer 4

black heads

Question 5

what is responsible for increased sebum production

Answer 5

androgens

Question 6

typical areas affected by acne

Answer 6

face, back chest

- areas rich with sebaceous glands

Question 7

mild acne criteria

Answer 7

scattered papule + pustules

Question 8

moderate acne criteria

Answer 8

numerous papule, pustules + mild atrophic scarring

Question 9

severe acne criteria

Answer 9

cysts, nodules and significant scarring

Question 10

types of acne scarring

Answer 10

atrophic - shallow or ice-pick

hypertrophic / keloid

Question 11

treatment pathway for acne

Answer 11

1. single topical treatment only
   - benzoyl peroxide
   - topical retinoid e.g. tretinoin, adapalene
2. combination topical therapy
   - add topical antibiotic e.g. clindamycin
   - or combine benzoyl peroxide + topical retinoid
3. oral antibiotic e.g. tetracycline
   - moderate acne / high scarring risk
   - use in combo with benzoyl peroxide / topical retinoid
4. Oral isotretinoin
   - severe acne if oral antibiotics have been ineffective

Question 12

what else can be used in combination with topical agents in females

Answer 12

combined oral contraceptives

- dianette : anti-androgren properties

Question 13

mechanism of action benzoyl peroxide

Answer 13

peeling agent that is antibacterial, anti-inflammatory and anti-comedonal

Question 14

mechanism of action topical retinoid

Answer 14

reduced follicular hyperkeratinisation - anti-comedonal

Question 15

mechanism of action oral isotretinion

Answer 15

reduced sebum production

Question 16

side effects of oral isotretinoin

Answer 16

dry skin + lips 
teratogenic
depression 
nose bleeds
photosensitivity

Question 17

side effects of oral tetracyclines

Answer 17

GI upset
photosensitivity
angioedema

Question 18

side effects of topical retinoids

Answer 18

stinging, irritation, erythema + peeling

Question 19

what type of contraceptive may exacerbate acne

Answer 19

progesterone rich/progesterone only pills

Question 20

what hormones are in dianette

Answer 20

cyproterone acetate + oestrogen

Question 21

indications for roaccutane (oral isotretinoin)

Answer 21

nodulo-cystic acne 
inadequate response to therapy / relapse after adequate antibiotic therapy 
significant scarring 
post inflammatory hyperpigmentation 
severe psychological impairment

Question 22

features of acne rosacea

Answer 22

papules, pustules + erythema on nose, chin, cheeks + forehead
NO comedones
Often telangectasia
Flushing 
Rhinophyma - tissue hypertrophy on nose

Question 23

who is most affected by acne rosacea

Answer 23

females 30-40s

Question 24

exacerbating factors in acne rosacea

Answer 24

sudden temperature change
alcohol
spicy food

Question 25

treatment for acne rosacea

Answer 25

mild: topical metronidazole
severe: oral tetracycline