Acne and Rosacea

Question 1

What is Acne?

Answer 1

Chronic inflammation of the pilosebaceous units

Question 2

What is the pathogenesis of acne?

Answer 2

Poral occlusion
Bacterial colonisation of the duct
Dermal inflammation
Increased sebum production

Question 3

What bacterium is the common cause of acne?

Answer 3

P.acnes

Question 4

How does duct occlusion occur?

Answer 4

Ductal hyper-cornification
Cosmetic occlusion e.g. make-up
Premenstrual oedema

Question 5

Comedones are always present in acne. Are black or white heads closed or open?

Answer 5

Closed = Whiteheads
Open = Blackheads

Question 6

What leads to increased sebum production in acne?

Answer 6

Increase in androgen production for various potential reasons

Question 7

The severity of the acne is graded according to presence of things such as pustules, papules, cysts, scarring. How is it graded?

Answer 7

Mild - scattered papules and pustules

Moderate - numerous papules, pustules and mild atrophic scarring

Severe - as above, cysts, nodules and significant scarring

Question 8

What aggravating factors of acne are there?

Answer 8

Diet - losing weight will decrease seborrhoea
Premenstrual
Sweating
UV radiation
Job - environment
Stress - acne excoriee (scratching acne)

Question 9

What are the mild, moderate and severe treatment options for acne?

Answer 9

Mild - topical treatment only
Moderate - Topical treatment and oral antibiotics e.g. doxycycline
Severe - Isotretinoin (Roaccutane)

Question 10

Benzoyl peroxide is a topical treatment used for acne. How does it work and what cautions should be taken?

Answer 10

Keratolytic - decreases comedones and duct occlusion
Anti-microbial
Anti-inflammatory

Cautions - erythema and peeling, bleaches clothing, hair, bedlinen and towels

Question 11

Retinoids (e.g. isotretinoin) are anti-comedonal in their action. What cautions should be taken?

Answer 11

Stinging, irritation, erythema and peeling are all possible - adjust dose depending on the side-effects