Acne Flashcards
Acne vulgaris is a common skin disorder which usually occurs in adolescence. It typically affects
the face, neck and upper trunk
Acne vulgaris pathophysiology
the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.
Acne vulgaris Epidemiology?
affects around 80-90% of teenagers, 60% of whom seek medical advice
acne may also persist beyond adolescence, with 10-15% of females and 5% of males over 25 years old being affected
Activity of sebaceous glands may be controlled by
androgen
acne vulgaris has colonisation by which bacteria?
anaerobic bacterium Propionibacterium acnes
Androgen levels are high in patients with acne vulgaris
false
levels are often normal in patients with acne
Acne is a disease of which part of the skin?
pilosebaceous unit
Comedones are due to a
dilated sebaceous follicle
Comedones:
if the top is closed ? is seen
if the top opens ? forms
if the top is closed a whitehead is seen
if the top opens a blackhead forms
In acne vulgaris Inflammatory lesions form when?
follicle bursts releasing irritants - papules and pustule formation
An excessive inflammatory response may result in: nodules, cysts
What type of scars do you get in acne vulgaris?
ice-pick scars
hypertrophic scars
Drug induced acne is associated with which drug
steroid use
Drug induced acne is monomorphic/polymorphic
monomorphic
What is acne fulminans?
very severe acne associated with systemic upset (e.g. fever).
acne fulminans mx?
Hospital admission is often required and the condition usually responds to oral steroids
Mild acne vulgaris?
mild: open and closed comedones with or without sparse inflammatory lesions
Moderate acne vulgaris?
moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
Severe acne vulgaris?
severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
A simple step-up management scheme often used in the treatment of acne - describe
Single topical therapy
Topical combination therapy
Oral antibiotics/COCP
Oral Isotretinoin
Diet is useful in controlling acne
false
There is no role for dietary modification in patients with acne.
Examples of single topical therapy?
topical retinoids, benzoyl peroxide
Examples of topical combination therapy?
topical antibiotic, benzoyl peroxide, topical retinoid
Which oral antibiotics are useful in acne vulgaris?
tetracyclines: lymecycline, oxytetracycline, doxycycline
Which antibiotic may be used in pregnancy?
erythromycin
When should tetracyclines be avoided?
tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age
Why is minocycline is now considered less appropriate in mx acne v?
possibility of irreversible pigmentation
a single oral antibiotic for acne vulgaris should be used for a maximum of
three months
Why should a topical retinoid or benzoyl peroxide always be co-prescribed with oral antibiotics
to reduce the risk of antibiotic resistance developing.
Topical and oral antibiotics should not be used in combination
true
complication of long-term antibiotic use?
Gram-negative folliculitis
mx Gram-negative folliculitis
- high-dose oral trimethoprim is effective if this occurs
combined oral contraceptives (COCP) are an alternative to oral antibiotics in women acne vulgaris
true
COCP can be prescribed alone in acne vulgaris
False
as with antibiotics, they should be used in combination with topical agents
WHat is Dianette (co-cyrindiol)? It is sometimes used in acne vulgaris because?
COCP
used as it has anti-androgen properties.
Dianette has an increased risk of?
venous thromboembolism compared to other COCPs
When should dianette be used used?
it should generally be used second-line (COCP)
only be given for 3 months
women should be appropriately counselled about the risks
oral isotretinoin should only under specialist supervision
true
Contraindication retinoids?
pregnancy is a contraindication to topical and oral retinoid treatment
Acne rosacea is a chronic skin disease of unknown aetiology.
true
sx acne rosacea?
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
What can exacerbate sx acne rosacea?
Sunlight
Step wise mx of acne rosacea?
topical metronidazole/topical brimonidine gel
systemic antibiotics e.g. Oxytetracycline
laser therapy
More specifically (in acne rosacea) when is topical metronidazole used?
may be used for mild symptoms
i.e. Limited number of papules and pustules, no plaques
More specifically (in acne rosacea) when is topical brimonidine gel used?
may be considered for patients with predominant flushing but limited telangiectasia
More specifically (in acne rosacea) when is laser therapy used?
laser therapy may be appropriate for patients with prominent telangiectasia
patients with a rhinophyma should be referred to dermatology
true
recommend daily application of a high-factor sunscreen in acne rosacea
true
Adverse effects retinoids?
teratogenicity dry skin, eyes and lips/mouth low mood raised triglycerides hair thinning nose bleeds intracranial hypertension Photosenstivity
In severe acne. wo-thirds of patients have a long-term remission or cure following a course of oral isotretinoin.
true
females should ideally be using one form of contraception if on retinoids
false
using TWO forms of contraception (e.g. Combined oral contraceptive pill and condoms)
the most common side-effect of isotretinoin
dry skin, eyes and lips/mouth
can lead to nose bleeds
isotretinoin treatment should not be combined with tetracyclines for what reason
intracranial hypertension
