Acne and Rosacea

Question 1

Where is acne seen?

Answer 1

Sites with most sebaceous glands

–> face, upper back and anterior chest

Question 2

What are the clinical features in acne?

Answer 2

Comedones
- open = blackhead
- closed = whitehead
Pustules + papules
Cysts
Erythema
Scarring - ice pick, texture changes

Question 3

What are the features of mild acne?

Answer 3

Scattered papules and pustules

Question 4

What are the features of moderate acne?

Answer 4

Numerous papules/pustules

+ mild atrophic scarring

Question 5

What are the features of severe acne?

Answer 5

Same as moderate + cysts, nodules and significant scarring

Question 6

How is mild acne managed?

Answer 6

Topical treatment only

Question 7

How is moderate acne managed?

Answer 7

Topical treatment +

Oral antibiotic or Dianette (if female)

Question 8

How is severe acne managed?

Answer 8

Isotretinoin (Roaccutane)

Question 9

What are the options for topical treatment?

Answer 9

Benzoyl peroxide
Retinoids e.g. tretinoin, adapalene
Antibiotic creams

Question 10

What are the side effects of benzoyl peroxide?

Answer 10

Erythema/peeling

Bleaches clothes

Question 11

What are the side effects of topical retinoids?

Answer 11

Stinging, irritation, erythema and peeling
–> apply emollient after
Don’t use in pregnancy

Question 12

What antibiotic creams are available?

Answer 12

Clindamycin
Tetracycline
Erythromycin
–> available in preparations with benzoyl peroxide or retinoids

Question 13

Which oral antibiotics are used?

Answer 13

Erythromycin or tetracyclines

Question 14

How long do oral antibiotics need to be used for to see effect in acne?

Answer 14

3-6 months

Question 15

What are the indications for using isotretinoin (roaccutane)?

Answer 15

• nodulocystic acne
• inadequate response to therapy
• relapse after antibiotics
• significant scarring/hyperpigmentation
• severe psychological impairment

Question 16

What are the side effects of isotretinoin?

Answer 16

Dry skin, lips and eyes
Nose bleeds
Skin frailty --> avoid waxing
Hyperlipidaemia
Abnormal LFTs
Teratogenic
Mood alteration --> increased suicide risk
Arthralgia
Benign intracranial hypertension --> avoid concurrent use of tetracyclines

Question 17

How is the teratogenic risk managed in someone taking isotretinoin?

Answer 17

Must use 2 forms of contraception for

• 1 month before starting
• during
• 1 month after stopping drug

–> pregnancy test done every month

Question 18

Who gets rosacea?

Answer 18

Adults age 30-40

Women > men

Question 19

What are the clinical features of rosacea?

Answer 19

Papules, pustules + erythema
--> nose, chin, cheeks and forehead
Prominent flushing
Rhinophyma --> large unshapely nose
Telangiectasis
Ocular inflammation

Question 20

How might the flushing be triggered in rosacea?

Answer 20

Sudden temperature change
Alcohol
Spice

Question 21

What is the management of rosacea?

Answer 21

Topical metronidazole
Oral tetracycline long term
Low dose roaccutane long term

Avoid topical steroids