Acne and Rosacea Flashcards

1
Q

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

A

Face, chest and back

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2
Q

What happens in acne?

A

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

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3
Q

Comedones?

A

Blocked follicles

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4
Q

Why is acne treatment important?

A

Reduces potential for scarring

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5
Q

What is another term for an open comedo?

A

Blackhead

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6
Q

What is another term for an closed comedo?

A

Whitehead

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7
Q

What age range is peak for acne vulgaris?

A

15-18yrs

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8
Q

Is acne more severe in males or females?

A

Males

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9
Q

How can acne have other impacts on patients?

A

Can have a psychological impact

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10
Q

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

A

Papulopustular acne

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11
Q

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

A

Sudden onset of acne
Fever
Unwell
Joint pain

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12
Q

What is the treatment for acne fulminans?

A

Low dose Isotretinoin but cover with prednisolone

->Isotretinoin can make it worse before better

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13
Q

What is the first line treatment for acne?

A

Topical e.g. benzoyl peroxide

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14
Q

What are some other treatments of acne?

A

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

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15
Q

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

A

Systemic treatments

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

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16
Q

Which antibiotics are often used in the treatment of acne?

A

Tetracyclines

->avoid in those under twelve as can stain teeth

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17
Q

Trade name for isotretinoin?

A

Roaccutane

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18
Q

What type of medication is isotretinoin?

A

Retinoid medication

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19
Q

What is the most effective treatment of acne?

A

Isotretinoin

20
Q

What is isotretinoin reserved for?

A

Other treatment failure
Evidence of scarring
Severe acne
Acne fulminans

21
Q

Who can prescribe isotretinoin?

A

Dermatologists in secondary care
Cannot be prescribed by a GP

22
Q

What are the side effects of Isotretinoin?

A

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

23
Q

What can Isotretinoin raise levels of in the blood?

A

Can raise triglycerides

24
Q

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

A

Need to stop tetracycline antibiotics

25
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
26
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
27
What is acne rosacea?
Chronic inflammation of the pilosebaceous unit, like acne vulgaris, but there is also changes in the cutaneous vasculature
28
Where on the body does acne rosacea occur?
Face ->unusual to be other sites
29
What age group is more likely to develop acne rosecea?
30-50
30
What factors can make acne rosacea more evident?
Alcohol Spices Emotion Hot drinks
31
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)
32
What are the treatments for milder forms of acne rosacea e.g. papular pustular?
Topical treatments e.g. metronidazole gel, azeleic acids
33
Which antibiotics can be used in the treatment of acne rosacea?
Tetracyclines Erythromycin
34
Which other alternative treatments can be used for acne rosacea?
Low dose isotretinoin Light based treatments Laser
35
Which skin types is acne keloidalis nuchae most seen in?
Skin types V and VI ->darker skin tones
36
Where on the body is acne keloidalis nuchae most commonly seen?
Posterior scalp and nape of neck
37
What happens in acne keloidalis nuchae?
Chronic folliculitis and scarring hair loss
38
What are some of the treatment options for acne keloidalis nuchae?
Topical steroids Antimicrobial wash Oral antibiotics Isotretinoin Laser hair removal
39
What happens in Hidradenitis suppuritiva?
Recurrent boils and abcesses Go on to develop sinus tract formation
40
Which parts of the body doe Hidradenitis suppuritiva usually affect?
Axillae Groin Pereneum Submammary
41
Who is Hidradenitis suppuritiva more common in?
Patients who smoke or are overweight so important to advise on lifestyle modification
42
What are some of the treatment options for Hidradenitis suppuritiva?
Lifestyle modification Topical wash Tetracycline
43
Which tetracycline is better tolerated- lymecycline or doxycycline?
Lymecycline
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?
Beyond topical creams so probably lymecycline Thinking of contraceptive pill as next step as required due to the premenstrual flare
45
There is no improvement and the patient is now getting scarring. What would you consider next?
Isotretinoin so referral to dermatology
46