Acne and Rosacea

Question 1

ACNE VULGARIS
i) what is it? name four things that can cause it?
ii) name three things it can manifest as?
iii) what starts the process and leads to microcomedone formation? what happens later to form a closed comedone?
iv) name three drugs that can exacerbate it

Answer 1

i) inflammation of pilosebaceous units
* caused by increased sebum production, hair follicle clogged by oil and corneocytes, bacteria (p.acne), inflammation
ii) can manifest as comedones, papules, pustules, cysts
iii) increased corneocytes in the pilosebaceous unit and hyperkeratosis > microcomedone formation
* then acccumulation of shed keratin and sebum > closed comedone
* then inflam and comedone rupture
iv) drugs = lithium, isoniazid, GCs, COCP and stress

Question 2

ACNE CLINICAL MANIFESTATIONS AND TREATMENT
i) what is a blackhead aka? what is a whitehead aka?
ii) name two sequale?
iii) what needs to be assessed in management? what should be avoided?
iv) what can be given for mild acne? (3)
v) what is given for moderate acne? what two things should not be used together? what can be given if there is a large cyst?
vi) what can be given for severe acne?

Answer 2

i) blackhead = open comedone, whitehead = closed comedone
ii) sequale - scarring, hypo or hyperpigmentation
iii) assess psychosocial impact and avoid oil based cosmetics
iv) mild = OTC benzoyl peroxide or topical retinoids
* topical abx eg clindamycin
* azaelic or salycylic acid, nicatinamide
v) moderate - there are more inflammatory lesions - use combo therapy of oral abx and topical therapy
* dont use topical abx and topical therapy together
* if large cyst give intralesional steroid
vi) severe - give isotretinoin

Question 3

SEVERE ACNE
i) what is isotretinoin a derivative of? name two instances that it is contraindicated
ii) name three side effects of isotret?

Answer 3

i) deriv of vitamin A
CI in pregnancy, drug interaction eg tetracycline
ii) SEs are low mood, dry lips, photosensitivity

Question 4

ROSACEA
i) what is it? how is it characterised? what is the most common age of onset?
ii) what is rhinophyma? which two skin types does it mostly affect?
iii) what is the cause? what organism may be the cause?
iv) name three clinical manifestations
v) do you get comedones?

Answer 4

i) fixed centrofacial erythema in charactersitic pattern that periodically intensifies
* thickening of skin plus flushing/pustules/papules/telengiectasia
* age of onset between 30-50yrs
ii) rhinophyma = affects the nose and is mostly seen in males
may be caused by dermodex mites
iv) clin maifest = flushing/red of face when change of temp, exposure to sun/heat, may be preceeded by acne
v) dont get comedones

Question 5

SUBTYPES OF ROSACEA
i) which type has flushing for >10 mins, persistent erythema?
ii) which type has persistent erythema with pap and pustules
iii) which type has skin thickening?
iv) name three manifestations of ocular rosacea

Answer 5

i) erythemato telengiectasia
ii) papulopustular
iii) phymatous
iv) ocular = dry, burning, stinging eyes, sensitive to light, gritty eye, conjunctivitis

Question 6

MANAGEMENT/TX OF ROSACEA
i) what can be given for erythema? (2) what can be given for inflam papules and pustules? (2)
ii) what is given for ocular involvement? who should patient be refered to?
iii) what can be given for flushing? when may abx be given? (3)
iv) what physical tx can be given for erythema? what physical tx for phymatous (non inflammatory) (3)

Answer 6

i) topical brimonidine tartare (alpha1 agonist) for erythema
ivermectin cream/azelaic acid/metronidazole for pap/pustules
ii) ocular involvement - artificial tears and refer to opthalmology
iii) flushing - propanolol or clonidine
abx if inflammatory pap and pustules, phymatous or ocular involvement
iv) erythema - light therapy/laser
phymatous - co2, sx resection, electrosurgery, laser