Acne & Rosacea Flashcards
What is acne ?
- Acne is a common chronic inflammatory skin disorder affecting the pilosebaceous unit. Characterised by blockage and inflammation of this unit.
- It presents with lesions which can be non-inflammatory, inflammatory or a mixture of both.
- There are several variants, the most common being acne vulgaris
What is the pilosebaceous unit?
It consists of the hair shaft, the hair follicle, the sebaceous gland, and the erector pili muscle
Describe the pathogenesis for the development of acne/acne vulgaris
- Increased Androgens at puberty
- Increased Androgen sensitivity of sebaceous glands
- This promotes increased keratin and sebum production
- Increased Keratin pluggs up the piliosebaceous ducts which leads to comedones (blackheads / whiteheads)
- Increased sebum results in cystic dilatation of the reaming unit
- Subsequent colonisation of plugged up units with Propionobacterium acnes
- Rupture of pluuged, distended and infected units releases debris into the dermis, eliciting an intense foreign body granulomatoud reaction
- May heal with scarring
Who is acne most common in ?
- Acne affects males and females of all races and ethnicities.
- It is most prevalent in adolescents and young adults, with 85% of 16 to 18 year-olds affected.
- However, it may sometimes occur in children and adults of all ages.
Describe the typical distribution of acne
It typically affects the face, neck and upper trunk
What are the non-inflammatory lesions which can develop in acne ?
- Comedones which may be open (blackheads)
- Closed (whiteheads)
- Or microcomedones (clinically invisible).
What are the inflammatory lesions of acne which can develop?
- Papules (small tender bumps) and pustules (white or yellow squeezable spots) – superficial raised lesions (<5 mm in diameter).
- Nodules (large painful red lumps) or cysts (fluctuant swellings) (>5mm in diameter) – deeper, palpable lesions which are often painful
- In very severe acne nodules may track together and form sinuses (acne conglobata).
- Also associated erythema
What are the secondary features of acne which may be seen ?
- Scarring — atropic/ice pick or hypertrophic/keloid scars may be seen.
- Pigmentation — post-inflammatory depigmentation or hyperpigmentation (dark marks from old spots)
- Erythematous macules (red marks from recently healed spots)
- Seborrhoea (excessivley oily skin)
How is acne graded ?
- Mild acne — predominantly non-inflamed lesions (open and closed comedones) with few scattered papules & pustules (inflammatory lesions)
- Moderate acne — numerous papules, pustules & mild atrophic scarring
- Severe acne — widespread inflammatory papules, pustules and cysts, nodules and significant scarring
Grade the following pic of acne
Moderate Papulo-pustular acne with atrophic scarring
Where on the body does scarring from acne especially occur ?
On the cheeks
List some of the aggrevating factors of acne
What is acne excoriée?
Acne excoriée, also known as “picker’s acne,” results when acne lesions are compulsively squeezed and scratched, resulting in scabs and scars.
How is acne diagnosed ?
Clinically
What is the management of mild acne ?
- 1st line = topical retinoid (e.g. adapelene) if mainly open & closed comedones
- 1st line = topical benzoyl peroxide if mixed comedones & inflammatory lesions
- 2nd line = switch to retinoid or benzoyl peroxide depending on which was started
- 3rd line = combination preparation of any of the following; Topicalbenzoyl peroxide/antibiotic (e.g. Duac®) or retinoid/antibiotic (e.g. Aknemycin Plus®) or benzoyl peroxide/retinoid (e.g. Epiduo®)
What is the management of moderate acne ?
- 1st line = topical benzoyl peroxide e.g. Acnecide + Oral antibiotic e.g. erythromycin, doxycycline (or other tetracyclines) OR COC pill Dianette (Co-cyprindol) as an alternative to oral antibiotics in women
- 2nd line = swtich benzoyl peroxide to topical retinoid e.g. adapalene & continue oral antibiotic
- 3rd line = switch the oral antibiotic & continue topical treatment
What is the management of severe acne ?
1st line = isoretinoin (Roaccutane). Refer to dermatology
What are the main adverse effects of isoretinoin ?
- teratogenicity: females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
- dry skin, eyes and lips/mouth: the most common side-effect of isotretinoin
- low mood*
- raised triglycerides
- hair thinning
- nose bleeds (caused by dryness of the nasal mucosa)
- intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
- photosensitivity
What are the typical features of acne rosacea ?
Typically affects nose, cheeks and forehead:
- Facial flushing & sensitive skin is often first symptom
- telangiectasia are common
- later develops into persistent erythema with papules and pustules
- rhinophyma (a large, red, bumpy or bulbous nose)
- ocular involvement: blepharitis
- sunlight may exacerbate symptoms
