Acne

Question 1

What are the type sof Acne?

Answer 1

Acne Vulgaris

Acne Rosacea

Question 2

Who is most effected by Vulgaris and rosacea?

Answer 2

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

Question 3

Explain the pathogenesis of Acne Vulgaris?

Answer 3

A disease of the Pilo-sebaceous unit:

1) Keratinocytes at the follicle top become sticky and aggregate instead of shedding forming a comedone (Plug)
2) Sebum becomes more viscous and so harder to clear

Sometimes commensal bacteria cause inflammation

Question 4

What bacteria is most responsible for inflammation in acne vulgaris?

Answer 4

Propionobacterium acnes

Question 5

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

Answer 5

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

Question 6

What are the main types of Acne scars?

Answer 6

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

Question 7

Qiuck list of the treatments for Acne Vulgaris?

Answer 7

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)

Question 8

How do retinoids help acne vulgaris?

Answer 8

Vit A Derivatives applied topically can unstick comodones

Often combined with BPO

Question 9

How does Benzoyl Peroxide help acne vulgaris?

Answer 9

Has an anti-inflammatory effect

Hence often combined with Retinoids anti-comodone effect

Question 10

What anti-biotics are used for Acne Vulgaris?

Answer 10

Topically

• Erythromycin
• Tetracyclines
• Clindamycin

Non-topical:

• Erythromycin
• Tetracyclines

Question 11

How do you prevent resistance to acne anti-biotics?

Answer 11

Use somewhat sparingly and combine with BPO

Question 12

What is dianette?

Answer 12

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

Used for women with acne Vulgaris

Question 13

What is isotretinoin?

Answer 13

Trade name Roaccutane
Its an expensive non-topical retinoid (Vit A derivative) prescribable only by specialists.

1mg/kg/day for 16 wks (generally given in smaller doses to reduce dry skin side effects)

Question 14

Pros and cons of isotretinoin?

Answer 14

• 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

Question 15

Describe the pathogenesis of Acne Rosacea?

Answer 15

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

Question 16

What are the subtypes of Rosacea?

Answer 16

• 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

Question 17

How does ocular rosacea occur?

Answer 17

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

Question 18

How is does rosacea look?

Answer 18

Ace of clubs distribution
Rarely appears off face

Many patients get pronounced flushing on alcohol, hot drinks, emotion and spicy foods

Question 19

Quick list of rosacea treatments

Answer 19

Topical:

• Anti-biotics
• Azeleic Acid
• Ivermectin
• Brimonidine

Non-topical:

• Anti-biotics
• Isotretinoin
• Light based therapies

Question 20

what Anti-biotics are used for rosacea and why?

Answer 20

Metronidazole topically
Tetracyclines systemically

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

Question 21

How is isotretinoin different for rosacea?

Answer 21

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

Question 22

what subtypes of rosacea have special treatments?

Answer 22

Erythemato-telangectasic Rosacea is best treated with light therapies

Question 23

How does azeleic acid work?

Answer 23

It kills acne bacteria and inhibits keratin production

Used for Acne Rosacea

Question 24

How does Ivermectin work?

Answer 24

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

Question 25

How does brimonidine work?

Answer 25

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