Acne and Rosacea

Question 1

Which areas of the body can be affected by acne vulgaris?

Answer 1

Face, chest and back

Question 2

What happens in acne?

Answer 2

Keratinocytes or skin cells become sticky due to increase in sebum viscosity which leads to comedones.

Question 3

Comedones?

Answer 3

Blocked follicles

Question 4

Why is acne treatment important?

Answer 4

Reduces potential for scarring

Question 5

What is another term for an open comedo?

Answer 5

Blackhead

Question 6

What is another term for an closed comedo?

Answer 6

Whitehead

Question 7

What age range is peak for acne vulgaris?

Answer 7

15-18yrs

Question 8

Is acne more severe in males or females?

Answer 8

Males

Question 9

How can acne have other impacts on patients?

Answer 9

Can have a psychological impact

Question 10

What type of acne is the most common presentation of acne?

Answer 10

Papulopustular acne

Question 11

Acne fulminans is rare and severe.
How does it present?

Answer 11

Sudden onset of acne
Fever
Unwell
Joint pain

Question 12

What is the treatment for acne fulminans?

Answer 12

Low dose Isotretinoin but cover with prednisolone

->Isotretinoin can make it worse before better

Question 13

What is the first line treatment for acne?

Answer 13

Topical e.g. benzoyl peroxide

Question 14

What are some other treatments of acne?

Answer 14

Topical antibiotics- clindamycin and erythromycin
Retinoids
Combinations e.g. Duac (clindamycin and benzoyl peroxide)

Question 15

If topical treatments aren’t working on acne, what is considered next?

Answer 15

Systemic treatments

->antibiotics, anti-androgens (contraceptive pill), isotretinoin, UVB

Question 16

Which antibiotics are often used in the treatment of acne?

Answer 16

Tetracyclines

->avoid in those under twelve as can stain teeth

Question 17

Trade name for isotretinoin?

Answer 17

Roaccutane

Question 18

What type of medication is isotretinoin?

Answer 18

Retinoid medication

Question 19

What is the most effective treatment of acne?

Answer 19

Isotretinoin

Question 20

What is isotretinoin reserved for?

Answer 20

Other treatment failure
Evidence of scarring
Severe acne
Acne fulminans

Question 21

Who can prescribe isotretinoin?

Answer 21

Dermatologists in secondary care
Cannot be prescribed by a GP

Question 22

What are the side effects of Isotretinoin?

Answer 22

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

Question 23

What can Isotretinoin raise levels of in the blood?

Answer 23

Can raise triglycerides

Question 24

Which medication needs to be stopped before someone is commenced on Isotretinoin?

Answer 24

Need to stop tetracycline antibiotics

Question 25

What is the treatment for scarring due to acne?

Answer 25

Treat inflammation first

Depends on type of scarring- intralesional steroid, excision of ice pick scars, laser, chemical peels

Question 26

How long do patients who have been on Isotretinoin have to wait before starting scar treatment?

Answer 26

A year

->this is because the medicine makes skin more sensitive

Question 27

What is acne rosacea?

Answer 27

Chronic inflammation of the pilosebaceous unit, like acne vulgaris, but there is also changes in the cutaneous vasculature

Question 28

Where on the body does acne rosacea occur?

Answer 28

Face

->unusual to be other sites

Question 29

What age group is more likely to develop acne rosecea?

Answer 29

30-50

Question 30

What factors can make acne rosacea more evident?

Answer 30

Alcohol
Spices
Emotion
Hot drinks

Question 31

Name some of the sub-types of acne rosacea.

Answer 31

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)

Question 32

What are the treatments for milder forms of acne rosacea e.g. papular pustular?

Answer 32

Topical treatments e.g. metronidazole gel, azeleic acids

Question 33

Which antibiotics can be used in the treatment of acne rosacea?

Answer 33

Tetracyclines
Erythromycin

Question 34

Which other alternative treatments can be used for acne rosacea?

Answer 34

Low dose isotretinoin
Light based treatments
Laser

Question 35

Which skin types is acne keloidalis nuchae most seen in?

Answer 35

Skin types V and VI

->darker skin tones

Question 36

Where on the body is acne keloidalis nuchae most commonly seen?

Answer 36

Posterior scalp and nape of neck

Question 37

What happens in acne keloidalis nuchae?

Answer 37

Chronic folliculitis and scarring hair loss

Question 38

What are some of the treatment options for acne keloidalis nuchae?

Answer 38

Topical steroids
Antimicrobial wash
Oral antibiotics
Isotretinoin
Laser hair removal

Question 39

What happens in Hidradenitis suppuritiva?

Answer 39

Recurrent boils and abcesses

Go on to develop sinus tract formation

Question 40

Which parts of the body doe Hidradenitis suppuritiva usually affect?

Answer 40

Axillae
Groin
Pereneum
Submammary

Question 41

Who is Hidradenitis suppuritiva more common in?

Answer 41

Patients who smoke or are overweight so important to advise on lifestyle modification

Question 42

What are some of the treatment options for Hidradenitis suppuritiva?

Answer 42

Lifestyle modification
Topical wash
Tetracycline

Question 43

Which tetracycline is better tolerated- lymecycline or doxycycline?

Answer 43

Lymecycline

Question 44

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?

Answer 44

Beyond topical creams so probably lymecycline

Thinking of contraceptive pill as next step as required due to the premenstrual flare

Question 45

There is no improvement and the patient is now getting scarring.

What would you consider next?

Answer 45

Isotretinoin so referral to dermatology