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Y4 Lecture Day III > Acne > Flashcards

Acne Flashcards

1
Q

What type of bacteria is Propionibacterium acnes?

A

Gram-positive rod

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2
Q

Epidemiology Acne Vulgaris

A
  • affects around 80-90% of teenagers
  • acne may also persist beyond adolescence, with 10-15% of females and 5% of males over 25 years old being affected
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3
Q

Pathophysiology of acne

A
  • follicular epidermal hyperproliferation → formation of a keratin plug →obstruction of the pilosebaceous follicle
  • activity of sebaceous glands may be controlled by androgen, although levels are often normal in patients with acne
  • colonisation by the anaerobic bacterium Propionibacterium acnes
  • inflammation
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4
Q

Presentation of acne

A

Non-inflammatory:

  • Open/black comedome
  • Closed/White comedome

Inflammatory:

  • Papules
  • Pustules
  • Nodules
  • Cysts
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5
Q

Types of scars in acne

A
  • ice-pick scars
  • hypertrophic scars
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6
Q

Types of comedones on both ends of the spectrum of acne severity (2)

A
  • mild end of spectrum→ comedomal acne, open comedomes → blackheads
  • more severe end → nodulocystic acne → leaves scarring
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7
Q

What’s acne fulminans?

A

Acne fulminans

  • very severe acne
  • associated with systemic upset (e.g. fever)
  • Hospital admission is often required and the condition usually responds to oral steroids
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8
Q

Treatment of different severites of acne

A

Mild

  • Comedonal – topical retinoid
  • Inflammatory – topical antimicrobial/antibiotic

Moderate

  • comedonal – topical retinoid
  • inflammatory – oral
  • Tetracycline
  • Macrolide
  • Trimethoprim
  • Spironolactone

Severe

  • Oral Isotretinoin
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9
Q

Considerations if treating acne with Tetracycline

A
  • Not <12 yo
  • Ensure not pregnant
  • Take night
  • Take with food
  • Not with milk
  • Caution of headache
  • Caution if on holiday
  • Interactions
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10
Q

Considerations if treating acne with timethoprim

A
  • Ensure not pregnant
  • 300mg BD
  • Interactions
  • Bloods baseline, every 6-8 weeks (bone marrow, renal)
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11
Q

Name (2) oral retinoids

A
  • Roaccutane
  • Isotretinoin
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12
Q

SEs of oral retinoids

A
  • Dry lips and skin
  • Epistaxis
  • Teratogenicity
  • Depression / Suicide
  • Abnormal LFTs, raised lipids
  • Initial drop in Neutrophils
  • Muscle pains
  • Raised intracranial pressure
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13
Q

Can we combine oral retinoid and tetracycline?

A

Do not combine with tetracyclines as both raise ICP

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14
Q

Women in child-bearing age and prescribing oral retinoid. What to consider?

A

Women of a child bearing age need to be on 2 forms of contraception for 1 month before, during and 1 month after.

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15
Q

Can oral retinoid be prescribed if someone has a Hx of depression?

A

History of mental health disease – avoid isotretinoin

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16
Q

What’s oral retinoid class and MoA?

A

Derived from Vitamin A

MoA: Shrinks sebaceous unit, stabilises keratinisation and reduces inflammmation

17
Q

Algorithm for acne treatment

A
18
Q

Acne vulgaris vs acne rosacea - differences in features

A

Acne vulgaris:

  • comedomes or nodulocystic
  • commonly in teenagers
  • affecting the face chest and back

Rosacea:

  • no comedomes
  • only papules and pustules with erythema, telangiectasia and flushing
  • mainly affecting the central face
  • older age group
19
Q

Relate pathophysiology of acne to its treatment options

A
  • P. acne bacteria → Abx: anti-inflammatory and antibacterial. Benzoyl Peroxide – antibacterial
  • Chronic inflammation (due to bacteria) topical retinoid – anti-inflammatory and comedolytic
  • Increased sebum production →Isotretionon – reduces sebum and inflammation
20
Q

Features of acne rosacea

A
  • typically affects nose, cheeks and forehead
  • flushing is often the first symptom
  • telangiectasia are common
  • later develops into persistent erythema with papules and pustules
  • rhinophyma
  • ocular involvement: blepharitis
  • sunlight may exacerbate symptoms/
21
Q

Management of Acne Rosacea

A
  • topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
  • topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
  • more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
  • recommend daily application of a high-factor sunscreen
  • camouflage creams may help conceal redness
  • laser therapy may be appropriate for patients with prominent telangiectasia
  • patients with a rhinophyma should be referred to dermatology

Y4 Lecture Day III (9 decks)

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