Acne and Rosacea

Question 1

Acne is a chronic inflammatory disease of what?

Answer 1

Of the pilosebaceous units.

• Increased sebum production.
• Bacterial colonisation of duct (P acnes)
• Dermal inflammation

Question 2

What is a closed and open microcomedone?

Answer 2

Closed = whitehead

Open = blackhead

Question 3

What are the main bacterias involved in acne?

Answer 3

Propionobacterium acnes

Staph epidermidis

• no relationship between number of bacteria and acne severity. In contrast with sebum secretion and ductal cornification which correlate well.
• High sebum concentration encourages p acnes colonisation.

Question 4

What are the 3 management stages of acne?

Answer 4

Mild = topical treatment only

Moderate = topical treatment and oral antibiotics or Dianette (females)

Severe = isotretinoin (roaccutane)

Question 5

Which is the only topical treatment that is anti-comedonal, anti-inflammatory and anti-microbial?

Answer 5

Benzoyl peroxide

Question 6

Mild acne treatment?

Answer 6

Prescribe a single topical treatment.
Prescribe a topical retinoid (tretinoin, isotretinoin, or adapalene) or benzoyl peroxide (especially if papules and pustules are present) as first-line treatment.
Prescribe azelaic acid if both topical retinoids and benzoyl peroxide are poorly tolerated.
Combined treatment is rarely necessary for mild acne.
Consider prescribing a standard combined oral contraceptive in women who require contraception, particularly if the acne is having a negative psychosocial impact.
Arrange follow up after about 6–8 weeks to review the effectiveness and tolerability of treatment,and the person’s compliance with the treatment.
If there is an inadequate response to treatment, see the section on Treatment failure for mild acne.
Advise the person to return sooner if the acne deteriorates significantly despite treatment.

Question 7

Moderate acne treatment?

Answer 7

In moderate acne, inflammatory lesions (papules and pustules) predominate. The acne may be widespread, there may be a risk of scarring, and there may be considerable psychosocial morbidity, all of which are indications for aggressive treatment.

Consider a single topical drug in people with limited acne which is unlikely to scar.
Prescribe benzoyl peroxide or a topical retinoid (tretinoin, isotretinoin, or adapalene) as they are most effective against inflammatory acne. Azelaic acid is an option if other drugs are poorly tolerated.
Consider combined topical treatment in people with moderate acne that is at risk of scarring.
A topical antibiotic combined with benzoyl peroxide or a topical retinoid is the preferred regimen, as it is proven to be effective and may limit the development of bacterial resistance. Where possible, a topical antibiotic course should be limited to a maximum of 12 weeks.
Topical retinoid combined with benzoyl peroxide is an alternative, but this may be poorly tolerated.
Consider an oral antibiotic combined with either a topical retinoid or benzoyl peroxide if there is acne on the back or shoulders that is particularly extensive or difficult to reach, or if there is a significant risk of scarring or substantial pigment change.
Oral tetracycline, oxytetracycline, doxycycline, or lymecycline are first-line options. Erythromycin is an alternative if tetracyclines are poorly tolerated or contraindicated (such as in pregnancy). Minocycline is not recommended.
Do not prescribe an oral antibiotic alone.
Do not combine a topical and an oral antibiotic.
Oral antibiotics should be limited to the shortest possible period, and discontinued when further improvement of acne is unlikely.
Consider prescribing a standard combined oral contraceptive in women who require contraception.
Arrange follow up after about 6–8 weeks to review the effectiveness and tolerability of treatment,and the person’s compliance with the treatment.
If there is an inadequate response to treatment, see the section on Treatment failure.
Advise the person to return sooner if the acne deteriorates significantly despite treatment.

Question 8

Management of acne rosacea?

Answer 8

For mild or moderate papulopustular acne rosacea (limited number of papules and pustules, with no plaques) prescribe topical metronidazole or azelaic acid

For moderate to severe papulopustular acne rosacea (extensive papules, pustules, or plaques), prescribe an oral tetracycline or erythromycin