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Dermatology > Acne > Flashcards

Acne Flashcards

1
Q

what are the 3 pathophysiological processes involved in the development of acne

A
  1. increase in sebum secretion
  2. hypercornification of follicular lining leading to sebaceaous gland obstruction
  3. overgrowth of p.acneus inside the pilosebaceous ducts leading to subsequent inflammation
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2
Q

what do androgen hormones do to sebaceous gland production

A

increase it

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3
Q

at what point do adrenergic surges happen

A

adrenarche (early puberty 10-14) and puberty

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4
Q

are patients with acne hyper-adrenergic

A

no, they have normal circulating levels but there may be a decrease in androgen binding globulins in the blood, or there is androgen hypersensitivity to normal levels

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5
Q

what causes artificial hyper-adrenergic states

A

anabolic steroids
PCOS
cushings

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6
Q

what causes micocomedomes in acne

A

kertinocytes lining the sebaceous gland become hyperkeratotic and start to shed causing duct occlusion - causing the ‘blocked pore’ , which is a build up of lipid-rich keratinous material

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7
Q

what causes p.acneus proliferation in the sebum ducts

A

the bacteria love the sebum rich environment and proliferate, aggregating proinflammatory mediators through neutrophil activation and cytokine release

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8
Q

what are blackheads and what causes them

A

open comedomes - they represent a distended pilosebaceous unit with a dilated orifice which is impacted with keratin and lipid

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9
Q

what are whiteheads

A

closed comedomes

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10
Q

what are the non-inflammatroy lesions of acne

A

closed and open comedomes

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11
Q

what are the inflammatory lesions of acne

A

small papules
inflammatory nodules
cysts
abscesses

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12
Q

why does a closed comedome bursting cause superficial irritation

A

it releases irritant fatty acids into the surrounding dermis and causes papules and pustules

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13
Q

what type of acne causes cystic acne

A

acne conglobate

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14
Q

when does acne cause scarring

A

usually post a large inflammatory period

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15
Q

what are the 2 broad types of scarring

A

loss of collagen (hypotrophic)

too much collagen (hypertrophic)

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16
Q

what are examples of hypotrophic scarring

A 
ice-pick scars
macular atrophic scars
box car scars
rolling scars 
deep atrophic scars
depressed fibrotic scars
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17
Q

what are examples of hypertrophic scars

A

keyloid scarring

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18
Q

where is keyloid scarring more common and in what population

A

upper back/chest/shoulders and more common with people with darker skin

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19
Q

what are some aggrevating factors for acne

A 
oily cosmetics 
facial treatments - sauna/massage 
squeezing lesions
OCP
potent steroids
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20
Q

what are the types of acne

A 
acne vulgaris
cystic acne/acne conglobate
acne fulminans
Acne excoriee
neonatal acne
infantile acne
endocrine acne
occupational acne
tropical acne
cosmetic acne
medication acne
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21
Q

what is the most common type of acne and by how much

A

acne vulgaris - 85% of 12-24 year olds with acne

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22
Q

when is acne vulgaris more likely to persist

A

women

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23
Q

what is acne fulminans

A

fulminant acne, a very serious but rare form occuring usually after a failure to treat cystic acne

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24
Q

what is acne excoriee and who is more likely to have it

A

rare acne where the lesions have been compulsively squeezed/scratches

associated more with younger girls + those with mental health problems

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25
Q

what are the features of infantile acne

A

2-12 months
M>F
usually facial

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26
Q

what is used to treat infantile acne

A

erythromycin

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27
Q

whats aspects of jobs are associated with occupational acne

A

working with hot oil/grease/tar

28
Q

what are the features of tropical acne

A

usually younger caucasians in hot climate, causing lesions on the trunk (usually back) - face is spared

resolves on moving to a milder climate

29
Q

how is acne classified usually

A

number of lesions and type of lesions

30
Q

what is the classification for acne

A

mild - <20 comedomes/<15inflammatory lesions/<30 both

moderate - 20-100 comedomes/15-50 inflammatory lesions/30-125 lesions

severe - >5 psuedocysts/>100 comedomes/>50 inflammatory lesions/>125 total

31
Q

what is the first line treatment for mild/moderate acne

A

topical agents only (Benozyl peroxide/retinoid), topical Abx if required, 1-2 a week up to daily if required

32
Q

what is the first line treatment for moderate acne (worse than mild-moderate), or mild-moderate acne with treatment failure

A

systemic antibiotic for 3 months with co-prescribed topical agent - usually doxycycline/limecycline
if no effect try another antibiotic (max 2)

33
Q

what happens if after 2 systemic antibiotics there is no resolution

A

dermatology referral (isotretinoin is probably required but only dermatologists can prescribe)

34
Q

what antibiotic tends to be avoided systemically, but it used in pregnancy

A

macrolides - such as erythromycin

35
Q

apart from treatment failure, what other acne cases require a dermatology referral

A 
any cases of severe acne 
?acne conglobata/fulminans
visible scars
severe psychological distress - no matter the severity of acne 
unsure of diagnosis
36
Q

what is the follow up reccomendation for acne treatment

A

follow up in 8-12 weeks
if acne clear - continue with topical treatment

Sufficient response = continue treatment for 12 weeks,

Insufficient response = consider adherence to treatment, adverse effects, progression to more severe acne, or use of comedongenic make up or face creams. Discuss a trial of an alternative formulation or move on to the next step in treatment if appropriate.

37
Q

what are retinoids

A

Vitamin A derivatives

38
Q

what are retinoids best against + why

A

comedomes, as they remove the keratin plug unblocking pores and allowing drainage, and they also have a secondary action that prevents new lesions forming

39
Q

what are side effects of retinoids

A

They’re teratogenic
irritation
photosensitivity
erythema

40
Q

what is benozyl peroxide

A

topical antibacterial agent

41
Q

what is benozyl peroxide best against

A

pustular/inflammatory/cystic acne

42
Q

what are side effects of retinoids

A

irritation
erythema
bleaching of clothes

43
Q

what are common topical antibiotic agents for acne (excluding benozyl peroxide)

A

erythromycin + clindamycin

44
Q

what must all topical antibiotics be prescribed with

A

benozyl peroxide

45
Q

what are first line systemic antibiotic agents for acne + what is the usual dose/course

A

doxycycline - 100mg O.D
lymecycline - 408mg O.D

max 3 months

46
Q

what are side effects of doxycycline/limecycline for systemic acne treatment

A

abnormal bone growth in foetus

teeth disclolouration

47
Q

who is doxycycline/lymecycline for systemic acne treatment contraindicated for

A

pregnant women
breastfeeding women
children under 12

48
Q

what is often used off-license as a 3rd line systemic antibiotic for acne treatment

A

trimethoprim

49
Q

how long should you continue an antibiotic with no effect

A

up to 6 weeks - if no change after 6 weeks change to another Abx

50
Q

what should you do when prescribing systemic and topical antibiotics for acne

A

make sure they are the same to prevent resistance

51
Q

when is hormonal treatment used for acne

A

mostly in women

52
Q

what is the hormonal option for acne

A

dianette pill - oral contraceptive containing oestrogen and an anti-androgen (cyproterone-acetate)

53
Q

when is hormonal treatment used for acne

A

in women with moderate-severe acne that failed to respond to systemic antibiotics, or women with hyperandrogenism

54
Q

when is hormonal treatment contraindicated for acne

A

pregnancy
breast feeding
PMH/FH of idiopathic thromboembolism
known/current thrombosis/emoblic disorder

55
Q

what is isotretinoin

A

retinoid used as last line result for acne

56
Q

what are the indications for isotretinoin

A

Severe acne

Active acne with scarring

Resistant disease

Rapid relapses

Psychiatric/psychological distress

57
Q

what does isotretinoin require if being taken by females

A

that they be on two forms of contraception - they can refuse but they have to sign a waiver

58
Q

what are the side effects of isotretinoin

A

Mood disturbance

Dry skin

Cracked lips,

Nose bleeds

Hair loss

Alteration of liver and lipid enzymes

High Teratogenicity

59
Q

what mandatory tests are required before commencing isotretinoin + during its course

A

FBC
LFT
pregnancy test if female
fasting lipids

done before starting then 1 month in

60
Q

how is isotretinoin used as an acne treatment

A

monotherapy - all other therapies should stop

61
Q

how long is an isotretinoin course

A

4-6 months

62
Q

whats the effectiveness of isotrerinoin

A

70-78% effective

63
Q

whats the typical dose for isotretinoin

A

500 micrograms/kg daily in 1–2 divided doses, increased if necessary to 1 mg/kg daily for 16–24 weeks, repeat treatment course after a period of at least 8 weeks if relapse after first course; maximum 150 mg/kg per course.

64
Q

when should you treat acne scarring

A

when the disease has settled

65
Q

what are options for treating acne scars

A 
Microdermabrasion 
Dermabrasion 
Laser resurfacing - atrophic scars
Punch biopsy  
Intralesional steroids  - keyloid scarring
66
Q

what are disadvantages of laser resurfacing treatment for atrophic acne scars

A

may cause pigment change

no nhs funding

67
Q

when are punch biopsies used for acne scar treatments

A

mainly for large ice pick scars

Dermatology (12 decks)

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