Acne

Question 1

Acne

Answer 1

• chronic inflammation of pilosebaceous unit
• Pathogenesis: increased sebum production, hormonal (androgens increase sebum), abnormal follicular keratinisation, occlusion of follicles, P. acne colonisation, genetic factors
• Non-inflammatory: open (blackheads) or closed comedones
• Inflammatory: papules and pustules, or nodules and cysts

Question 2

Acne vs Rosacea

Answer 2

Acne

• teenagers
• comedones, papules and pustules
• can affect other regions - back and chest

Rosacea

• flushing and telangectasia
• central face
• papules and pustules
• bulbous nose - ‘rhinophyma’
• specific triggers e.g. alcohol, spicy foods

Question 3

Acne vs Folliculitis

Answer 3

• Acne has polymorphic lesions
• Folliculitis presents as monomorphic pustules
• swab in acne is commonly negative as P. acne is difficult to culture VS in folliculitis (Staph aureus) is positive so useful to differentiate
• folliculitis treated conservatively or with topical or oral abx - fluclox

Question 4

Mild Acne - treatment

Answer 4

Topicals (alone or combination)

• antibiotics: erythromycin or clindamycin
• benzoyl peroxide (can bleach clothes or sheets)
• topical retinoids (differin, adaptalene) - good for comedones and reduce inflammation (shouldn’t be used in pregnancy as teratogenic)
• anti-septic washes with salicylic acid

Question 5

Moderate Acne - treatment

Answer 5

Oral Abx + benzoyl peroxine/topical retinoid

• Lymecycline, Oxytetracycline
• Erythromycin in pregnancy
• use tends to be 4-6 months
• combine with topical to reduce resistance
• do no give tetracycline to < 12 yrs

In females, consider:

• COCP (dianette) e.g. PCOS
• Spironolactone - avoid in pregnancy

Question 6

Severe Acne - treatment

Answer 6

Roaccutane (isotretinoin)
- oral retinoid derived from vitamin A - shrinks sebacious unit, stabilised keratinisation and reduces inflammation

Side effects

• can lead to dry lips and dry skin
• important S/E: extremely teratogenic*, depression/ suicide
• abnormal LFTs, lipids
• low neutrophils
• increased ICP**
• muscle pains
• women of childbearing age must be on 2 forms of contraception for 1 month before, during and after taking it
• • Never combine it with tetracyclines as can lead to raised ICP

Question 7

Rosacea - treatment

Answer 7

• topical metronidazole for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
• more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
• recommend daily application of a high-factor sunscreen
• patients with a rhinophyma should be referred to dermatology

Question 8

How do you treat acne in pregnancy?

Answer 8

• topical benzoyl peroxide

- oral abx you could consider is erythromycin