Acne and Rosacea Flashcards
Where is acne seen?
Sites with most sebaceous glands
–> face, upper back and anterior chest
What are the clinical features in acne?
Comedones - open = blackhead - closed = whitehead Pustules + papules Cysts Erythema Scarring - ice pick, texture changes
What are the features of mild acne?
Scattered papules and pustules
What are the features of moderate acne?
Numerous papules/pustules
+ mild atrophic scarring
What are the features of severe acne?
Same as moderate + cysts, nodules and significant scarring
How is mild acne managed?
Topical treatment only
How is moderate acne managed?
Topical treatment +
Oral antibiotic or Dianette (if female)
How is severe acne managed?
Isotretinoin (Roaccutane)
What are the options for topical treatment?
Benzoyl peroxide
Retinoids e.g. tretinoin, adapalene
Antibiotic creams
What are the side effects of benzoyl peroxide?
Erythema/peeling
Bleaches clothes
What are the side effects of topical retinoids?
Stinging, irritation, erythema and peeling
–> apply emollient after
Don’t use in pregnancy
What antibiotic creams are available?
Clindamycin
Tetracycline
Erythromycin
–> available in preparations with benzoyl peroxide or retinoids
Which oral antibiotics are used?
Erythromycin or tetracyclines
How long do oral antibiotics need to be used for to see effect in acne?
3-6 months
What are the indications for using isotretinoin (roaccutane)?
- nodulocystic acne
- inadequate response to therapy
- relapse after antibiotics
- significant scarring/hyperpigmentation
- severe psychological impairment
What are the side effects of isotretinoin?
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
How is the teratogenic risk managed in someone taking isotretinoin?
Must use 2 forms of contraception for
- 1 month before starting
- during
- 1 month after stopping drug
–> pregnancy test done every month
Who gets rosacea?
Adults age 30-40
Women > men
What are the clinical features of rosacea?
Papules, pustules + erythema --> nose, chin, cheeks and forehead Prominent flushing Rhinophyma --> large unshapely nose Telangiectasis Ocular inflammation
How might the flushing be triggered in rosacea?
Sudden temperature change
Alcohol
Spice
What is the management of rosacea?
Topical metronidazole
Oral tetracycline long term
Low dose roaccutane long term
Avoid topical steroids
