Acne and Rosacea Flashcards
What is acne?
Multi factorial skin disease which usually begins during puberty
Epidemiology of acne?
- Very common, around 80% experiences some form of acne during puberty
- Usually stops after puberty, but not rarely persists
- Man and women equally affected but severe acne more common in men
Pathogenesis of acne?
- Pilosebaceous duct hyperkeratosis
- Increased sebum secretion
- Colonization of the duct with Propionibacterium acnes
- Release of inflammatory mediators
What are comedones?
pores of hair follicles that have gotten blocked with bacteria, oil and dead skin cells to form a bump on your skin
Describe an early comedone?
- infundibulum
- hyperkaratosis
- corneocyte cohesiveness - androgen stimulation of sebum secretion
Describe a later comedone?
- accumulation of shed keratin and sebum
- formation of whorled lamellar concretions
What is a whitehead?
a skin lesion consisting of a hair follicle that is occluded with sebum and keratin, appearing white at the surface
- closed comedo with no disruption of the epidermis
What is a blackhead?
skin lesion consisting of a hair follicle that is occluded with sebum and keratin darkened by oxidation
- open comedo with disruption of the epidermis
Describe an inflammatory papule/pustule?
- Propionibacterium acnes proliferation
- sebaceous lobule regression
- mild inflammation
What is a nodule/cyst?
- marked inflammation
- scarring
What are the types of acne?
- Acne vulgaris
- Acne conglobata
- Acne excoriée
- Cosmetic / pommade
- Acne keloidalis
- Drug-induced
- Infantile
- Chloracne
What is acne vulgaris?
- Most common one
- Usually onset in puberty and usually remission after
Features of acne vulgaris?
- Papules
- pustules
- nodules
- comedones
What is acne conglobata?
is a highly inflammatory disease presenting with comedones, nodules, abscesses and draining sinus tracts
- is a severe form of acne
- begins at the ages between 18 and 30
What is acne excoriee?
aka pickers acne
- is a mild acne accompanied by extensive excoriations caused by the person picking at the pimples
What is pommade acne?
aka hairline acne
- type of acne caused by the use of hair styling products such as hair pomades, oils and gels that contain pore-clogging ingredients linked to comedone formation
What is peri-oral dermatitis?
- chronic facial dermatitis affecting the perioral region
- affecting primarily children and women 20-45 years
- Presumably caused by regular application of (glucocorticoid) creams and/or cosmetics
Clinical features of perioral dermatitis?
- Erythema with grouped papules and pustules
- Dry skin with painful burning and a sensation of tightness
- No residual scarring after resolution
What is acne keloidales?
Keloid around the hair follicle due to acne or folliculitis
Epidemiology of acne keloidales?
- dark-skinned people
- men
Distribution of acne keloidalis?
- Chest
- back
- Neck: acne keloidalis nuchae (also hair that grows in the skin)
What is acne keloidales nuchae?
- A chronic inflammatory skin condition affecting the nuchal and occipital region of the scalp
- Typically affects postpubertal individuals: usually men
Etiology of acne keloidales nuchae?
- Unclear; male preponderance suggests an association with increased androgen levels.
- Lesions are caused by an abnormal immune response to trauma.
Clinical features of acne keloidales nuchae?
The following features are circumscribed to the region surrounding the posterior hairline.
1. Keloid-like papules, plaques, and/or pustules
2. Cicatricial alopecia
3. Can cause itching, pain, and bleeding
What is pseudofollicultis barbae?
razor bumps - ingrown hairs
- An inflammatory skin condition characterized by firm, hyperpigmented, tender, pruritic papules and pustules on hair-growing areas on the lower face
- Often caused by an inflammatory skin reaction in response to short hair that becomes entrapped within the skin i.e ingrown hairs (e.g., after shaving)
- More common in Black males.
Treatment for Pseudofollicultis barbae?
- Grow the beard
- Long shave
- Shave in direction of hairs
- Topical retinoids, steroids
- Antiinflammatory antibiotics
- Laserepilation
Drug induced causes of acne?
- Hormones (androgens)
- Isoniazid
- Rifampicin
- Antiepileptics
- Steroids
General advice in acne treatment?
- Stop using very oily products!
- No Vaseline, oils or cosmetics - Keep the skin clean, but don’t wash it to often or with very warm water, use a gentle face wash, no aggressive soaps peelings and so on
- Don’t manipulate
Acne treatment?
- Topical
– Comedolytic
– Anti inflammatory - Oral antibiotics
- Retinoids
Comedolytic topical acne treatment?
- Benzoylperoxide 2.5-5-(10)% gel (stains)
- Tretinoin 0.02%- 0.1% cream / gel
- Adapalene
– Always be careful!!
Anti inflammatory topical acne treatment?
- Clindamycin 1% lotion
- Erythromycin 1-2% lotion
Postinflammatory hyperpigmentation topical treatment?
- Hydroquinone 2 (or 5) %
- Sun protection
Antibiotic acne treatment?
- Tetracycline
- minocycline
- doxycycline (3 months)
– Usually well tolerated, be careful with phototoxicity
Retinoid acne treatment?
Isotretinoin (on average 6-9 months up to cumulative dose (120-150 mg/kg)
– Very teratogenic!
Side effects of retinoids?
- dry skin - mainly mucsal
- headache
- muscle ache
- tiredness
Lab test to do before beginning retinoid therapy?
- cholesterol/triglycerides/liver function
- pregnancy test in women
What is rosacea?
- A chronic inflammatory skin condition of unclear etiology that presents with persistent central facial erythema, telangiectasia, roughness/scaling, and possibly papules/pustules
- which may be triggered by sun exposure, alcohol, or stress
- In severe cases, the nose develops a large, bulbous shape (rhinophyma)
Features of roacea?
- Erythematotelangiectatic
– Diffuse erythema/telangiectasia - Papulopustular
– Papules, Pustules
– NO comedones - Phymatous
– Rhinophyma - Ocular involvement as well as erythema
General measures in treatment of rosacea?
- Sun avoidance and photo protection
- Gentle skin care
- Avoiding triggers
What triggers rosacea?
- ultraviolet radiation exposure
- spicy foods
- hot or alcoholic beverages
- stress
- extreme temperatures (hot or cold)
Anti inflammatory treatment of rosacea?
- Metronidazole topical
- Oral tetracycline (doxycycline, minocycline)
- Oral isotretinoin
Anti redness treatment of rosacea?
- Laser
- Brimonidine topical
