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Dermatology > Acne > Flashcards

Acne Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the types of Acne? [2]

Types classified according to appearance [5]

A

Acne Vulgaris
Acne Rosacea

Appearance:
Neonatal
Acne excoriee
Papulopustular
Nodulocystic
Comedonal
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2
Q

Epidemiology
Acne vulgaris [3]
Acne rosacea [3]

  • Peak age of onset, gender predisposition, ethnic group
A

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

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3
Q

Explain the pathogenesis of Acne Vulgaris? [3]

A

Abnormal keratinisation of the infundibulum
- The hair follicle duct becomes blocked as corneocytes of the hair follicle stick together

Increased sebum
-Sebum becomes more viscous and so harder to clear

Infection with P. acne
- Infection with Propionibacterium acne (P.acne). Bacterium leads to an inflammatory reaction and pustule formation

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4
Q

What bacteria is most responsible for inflammation in acne vulgaris? [1]

A

Propionobacterium acnes - anaerobe

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5
Q

Explain the formation of whiteheads, blackheads and papules/pustules/cysts/scars etc

A

White heads - Closed Comedones, aka the skin has closed over the comedone

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

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6
Q

What are the main types of Acne scars? [3]

A

Atrophic scar- Common, indented, due to loss of collagen during healing

Hypertrophic scar - Uncommon, protruding, due to excess collagen from abnormal healing

Keloid scar - Rare, similar to hypertrophic but extend beyond the margins of the injury

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7
Q

Treatment of Acne Vulgaris

A

Topical:
Retinoids (Vit A derivatives)
Benzoyl Peroxide (BPO)
Anti-biotics

Non-topical:

  • Anti-biotics
  • Anti-androgens (OCP Dianette)
  • Isotretinoin
  • Light based therapies (not on NHS)
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8
Q

How do retinoids help acne vulgaris? [3]

Side effects [7]

A

Inhibiting sebum excretion (contrast with topical retinoids, which do not reduce sebum excretion).
It does this by causing a temporary atrophy of the sebaceous glands.
Following a 4 month course, generally sebum excretion does not return to pre-treatment levels for several years.

Highly teratogenic (2 methods of contraception
Skin and mucosal dryness
Depression
Hypercholesterolemia, hypertriglyceridemia
Deranged LFTs
Arthralgia, myalgia

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9
Q

How does Benzoyl Peroxide help acne vulgaris? [1]

A

Has an anti-inflammatory effect

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10
Q

What anti-biotics are used for Acne Vulgaris? [3]

A

Topically

  • Erythromycin
  • Tetracyclines, doxycycline
  • Clindamycin

Oral

  • Erythromycin if pregnant or <12y/o
  • Tetracyclines
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11
Q

How do you prevent resistance to acne anti-biotics? [1]

A

Use somewhat sparingly and combine with BPO

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12
Q

What is dianette? [1]

A

A Combined Oestrogen & Progesterone pill with an anti-androgen added

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13
Q

Dosage of isoretinoin [2]

A

1mg/kg/day for 16 wks

Generally given in smaller doses to reduce dry skin side effects

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14
Q

Pros [3] and cons of isotretinoin [3]

A
  • 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

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15
Q

Describe the pathogenesis of Acne Rosacea? [2]

What is the one clinical feature that differentiates it from vulgaris? [1]

A

Chronic relapsing remitting inflammation [1] of the PSU (Pilo-sebaceous unit) and cutaneous vasculature. [1]
Unlike Vulgaris, rosacea lacks comodones [1]

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16
Q

What are the subtypes of Rosacea? [4]

A
  • 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

17
Q

How does ocular rosacea occur? [3]

What is pre-rosacea [2]

A

Rosacea affects the meibomian glands in the eyelids [1], reducing tear film causing dry gritty eyes. [1] It eventually leads to sight loss if not treated. [1]

Pre-rosacea: flushing triggered by stress/blushing, alcohol and spices

18
Q

Presentation of rosacea - clinical appearance? [2]

A

Central symmetrical facial rash with erythema, telangiectasia, papule and pustules
Facial lymphedema
Inflammatory nodules
Blepharitis, conjunctivitis

19
Q

Quick list of rosacea treatments

A

Topical:

  • Antibiotics
  • Azeleic Acid
  • Ivermectin
  • Brimonidine

Non-topical:

  • Anti-biotics
  • Isotretinoin
  • Light based therapies
  • Laser therapy
20
Q

What Anti-biotics are used for rosacea and why?

A

1st line: Metronidazole topically
2nd line: Tetracyclines systemically eg doxy

They’re used for their anti-inflammatory effect rather than anti-bacterial

21
Q

How is isotretinoin different for rosacea?

A

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

22
Q

What subtypes of rosacea have special treatments?

A

Erythemato-telangectasic Rosacea is best treated with light therapies

23
Q

How does azeleic acid work?

A

It kills acne bacteria and inhibits keratin production

24
Q

How does Ivermectin work?

A

Kills parasitic mites which are believed to be part of the pathogenesis of acne rosacea

25
Q

How does brimonidine work? [2]

A

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

26
Q

Describe treatment for ocular acne rosacea [3]

A

Eyelid hygiene, ocular lubricants +/- CICLOSPORIN

27
Q

Describe treatment for: (dose, frequency)
Mild rosacea [2]
Moderate to severe [3]

A
  • Mild: METRONIDAZOLE gel or cream BD for 3-4m or topical 15% AZELAIC acid
  • Moderate or severe: oral TETRACYCLINE eg DOXYCYCLINE for 4m; ISORETINOIN or lasers rarely rqd
28
Q

Indications for isoretinoin [2]

A

Failure to respond to topical treatments and oral antibiotics when given for > 6 months
Scarring acne

29
Q

Re: antibiotic prescribing, when is it safe to say its not working?

A

Antibiotic prescribing in treatment of acne is generally long-term and patients can remain on antibiotics for years.
It is not possible to say that a drug is not working for acne unless the patient has been taking it for up to three months. Patients may need to be treated for several years or more.

30
Q

Most common reason that antibiotics fail in treatment of acne

A

Antibiotic resistance to P.acne can cause failure of treatment

31
Q

How do we decrease risk of resistance? [3]

A

Systemic antibiotic + Topical retinoid + Topical benzoyl peroxide

Dermatology (11 decks)

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