Acne Flashcards
Pathophysiology of acne
Chronic inflammatory disease of pilosebaceous unit
Androgens > increased sebum production > plugging w/ desquamated keratinocytes > bacterial proliferation (P. acnes) > inflammation
Significant genetic component
Epidemiology of acne vulgaris
Common in 18-24s
More severe in males
More persistent in females
Presentation of acne - non-inflammatory lesions
Comedones: small raised lesions from impaction and distenson of follicles by sebum/keratinocytes
Closed: Whiteheads
Open: Blackheads, from oxidised sebum
Presentation of acne - inflammatory lesions
Papules: Raised, red lesions
Pustules: Squeezable yellow/white spots
Nodules: Enlarged spots from severe inflammation
Presentation of acne - secondary lesions
Scars - from old spots, esp after excoriations
Pigmented macuels - from old spots, dark skin
Erythematous macules - from old spots, fair skin
Secondary causes of acne - endocrine
Ovarian: Tumours, PCOS
Adrenal: 21-a hydroxylase deficiency, tumours
Pituitary: Cushing’s, acromegaly, prolactinoma
Obesity
Secondary causes of acne - drugs
Phenytoin
Inhibitors of EGFR (cancer)
Moisturisers
Phenobarbitone
Lithium
Estrogen (OCP)
Steroids - incl. anabolic
Conservative management of acne
No evidence for diet
Smoking likely unhelpful
UV light ?helpful
Avoid abrasive/irritant skin treatment, scratching
Face washing helps
Medical management of mild acne
Comedones only - topical retinoids e.g. retin-A, adapalene
Papulopustular - combination Rx: abx (clindamycin, tetracycline), benzoyl peroxide, retinoid
3-4mo for effect
Retinoid + benzoyl irritant - gradual buildup of contact time
Apply to all spot-prone areas not just spots
Management of moderate acne
Topical retinoid/benzoyl +/- abx
Oral abx - tetracycline/emecycline/erythromycin - four-month course
Consider OCP in females - anti-adrogen cyproterone acetate
Baseline bloods for Roaccutane (isotretinoin)
Lipids, LFTs, pregnancy test (monthly)
Femalesmust be on OCP + advise 2nd contraception as well
Must not be on tetracycline - risk of BIH
Side-effects of Roaccutane
Anxiety/mood disturbance
Dry skin, eyes, etc..
Teratogenic
Lipid/LFT disturbance
Initial flare-up of acne
Acne variants contraindicated topical retinoid
Acne conglobata
Acne fulminans
Features of acne conglobata
Severe nodulo-cystic acne
Assoc w/ pilonidal sinus, scalp cellulitis, hidradenitis suppurative
Features of acne fulminans
Abrupt onset
Systemic unwellness - swinging fevers
Inflammatory, ulcerated, severe acne
Investigation of acne fulminans
Refer to derm, consider admission
B: FBC (leukocytosis, anaemia), ESR
O: Skin swabs - exclude 2ry infection w/ staph
X: Bone scans - radionuclide uptake in areas of pain
Management of acne fulminans
Oral prednisolone 0.5-1mg/kg per day for 4-8w
After steroid - isotretinoin course
NSAIDs for myalgia/arthralgia
Antiseptic wash
Potent Topical steroid BDS for granulating ulcers
Indications for immediate/urgent derm referral
Severe variant of acne (e.g. fulminans)
Severe nodulocystic disease that could benefit from oral isotretinoin
Social/psychological problems
Indications for routine derm referral for acne
Scarring despite management
Failed two courses of oral abx (3 months each)
Suspected underlying cause (e.g. PCOD)
Presentation of acne rosacea
Inflammation of blood vessels of skin - persistent, patchy redness but NOT SCALY (c.f. seb derm)
Affects face not trunk, usually symmetrical
Erythematous, telangiectasia, papules/pustules NO COMEDONES
3rd-4th decades, Hx of easy blushing/flushing
Rhinophyma - enlarged nose; eye involvement common
Conservatice management of rosacea
Avoid photoexacerbation
Avoid irritants (e.g. soap)
Topical management of rosacea
Metronidazole
Brimonidine (vasoconstriction) - temp reduction in redness, but risk of contact sensitisation
Cosmetic camouflage
NB: retionoid gel contraindicated
Medical management of rosacea
Oral abx (e.g. tetracycline) - treat papulopustular disease but not redness
Oral isotretinoin may help papulopustular
