Acne and Rosacea Flashcards
Which areas of the body can be affected by acne vulgaris?
Face, chest and back
What happens in acne?
Keratinocytes or skin cells become sticky due to increase in sebum viscosity which leads to comedones.
Comedones?
Blocked follicles
Why is acne treatment important?
Reduces potential for scarring
What is another term for an open comedo?
Blackhead
What is another term for an closed comedo?
Whitehead
What age range is peak for acne vulgaris?
15-18yrs
Is acne more severe in males or females?
Males
How can acne have other impacts on patients?
Can have a psychological impact
What type of acne is the most common presentation of acne?
Papulopustular acne
Acne fulminans is rare and severe.
How does it present?
Sudden onset of acne
Fever
Unwell
Joint pain
What is the treatment for acne fulminans?
Low dose Isotretinoin but cover with prednisolone
->Isotretinoin can make it worse before better
What is the first line treatment for acne?
Topical e.g. benzoyl peroxide
What are some other treatments of acne?
Topical antibiotics- clindamycin and erythromycin
Retinoids
Combinations e.g. Duac (clindamycin and benzoyl peroxide)
If topical treatments aren’t working on acne, what is considered next?
Systemic treatments
->antibiotics, anti-androgens (contraceptive pill), isotretinoin, UVB
Which antibiotics are often used in the treatment of acne?
Tetracyclines
->avoid in those under twelve as can stain teeth
Trade name for isotretinoin?
Roaccutane
What type of medication is isotretinoin?
Retinoid medication
What is the most effective treatment of acne?
Isotretinoin
What is isotretinoin reserved for?
Other treatment failure
Evidence of scarring
Severe acne
Acne fulminans
Who can prescribe isotretinoin?
Dermatologists in secondary care
Cannot be prescribed by a GP
What are the side effects of Isotretinoin?
Dry lips, epistaxis, dry brittle hair, mood disturbance, skin sensitivity, photosensitivity, headache
->the treatment works by drying out the mucous membranes so a lot of the side effects make sense
What can Isotretinoin raise levels of in the blood?
Can raise triglycerides
Which medication needs to be stopped before someone is commenced on Isotretinoin?
Need to stop tetracycline antibiotics
What is the treatment for scarring due to acne?
Treat inflammation first
Depends on type of scarring- intralesional steroid, excision of ice pick scars, laser, chemical peels
How long do patients who have been on Isotretinoin have to wait before starting scar treatment?
A year
->this is because the medicine makes skin more sensitive
What is acne rosacea?
Chronic inflammation of the pilosebaceous unit, like acne vulgaris, but there is also changes in the cutaneous vasculature
Where on the body does acne rosacea occur?
Face
->unusual to be other sites
What age group is more likely to develop acne rosecea?
30-50
What factors can make acne rosacea more evident?
Alcohol
Spices
Emotion
Hot drinks
Name some of the sub-types of acne rosacea.
Erythemato-telangietatic - redness
Papulo-pustular
Phymatous (male»female)
Ocular- dealt w by opthamologists
->Important to note that no comedones are present in acne rosacea (blackheads)
What are the treatments for milder forms of acne rosacea e.g. papular pustular?
Topical treatments e.g. metronidazole gel, azeleic acids
Which antibiotics can be used in the treatment of acne rosacea?
Tetracyclines
Erythromycin
Which other alternative treatments can be used for acne rosacea?
Low dose isotretinoin
Light based treatments
Laser
Which skin types is acne keloidalis nuchae most seen in?
Skin types V and VI
->darker skin tones
Where on the body is acne keloidalis nuchae most commonly seen?
Posterior scalp and nape of neck
What happens in acne keloidalis nuchae?
Chronic folliculitis and scarring hair loss
What are some of the treatment options for acne keloidalis nuchae?
Topical steroids
Antimicrobial wash
Oral antibiotics
Isotretinoin
Laser hair removal
What happens in Hidradenitis suppuritiva?
Recurrent boils and abcesses
Go on to develop sinus tract formation
Which parts of the body doe Hidradenitis suppuritiva usually affect?
Axillae
Groin
Pereneum
Submammary
Who is Hidradenitis suppuritiva more common in?
Patients who smoke or are overweight so important to advise on lifestyle modification
What are some of the treatment options for Hidradenitis suppuritiva?
Lifestyle modification
Topical wash
Tetracycline
Which tetracycline is better tolerated- lymecycline or doxycycline?
Lymecycline
17yr old girl attends clinic with history of worsening acne affecting face, chest and back.
Premenstrual flare
Affecting self confidence
What would be your thoughts regarding treatment?
Beyond topical creams so probably lymecycline
Thinking of contraceptive pill as next step as required due to the premenstrual flare
There is no improvement and the patient is now getting scarring.
What would you consider next?
Isotretinoin so referral to dermatology
