Acne Vulgaris Flashcards
Define Acne Vulgaris
Skin disease affecting polisebaceous units-chronic inflammation
can have wild varying presentations-from mild comedonal acne to severe nodulocystic acne
Peaks in adolescents but can be in any age group
either seen as types-comedonal, nodulocystic etc
or as severity (Mild/etc)
Mild-<20 comedones, not many inflamed
Moderate-20-100, more inflamed
severe- > 100. lesions are larger, more inflamed
very severe-very large lesions, numerous
acne Fulminans-systemic -
aetiology and risk factors of Acne Vulgaris
Polygenic and multi-factorial-highly hereditable but not only
Acne Vulgaris is characterised by blocked pores-development of extra sticky keratinocytes
As androgen push for sebaceous gland hyperplasia and hyperketatinsation at the top of follicule- bottleneck-blockage leads to accumulation–called a microcomedo
It then favours the proliferation of C.Acne gram+ (bacteria normally found in pilosebacous)
can go further-as proliferate the inflammatory can cause rupture–and if continues enough can lead to scarring
other causes-occupational acne (oils and cosmetics) Chloracne-exposures to hydrocarbonposure Acne mechanica-frictional obstruction Topical Acne-extreme heat Radiation acne-post radiation
RISK FACTORS- Teenagers FHx/Genetic Greasy skin Steroid based medications endocrine disorders with hyperandrogen stress Obesity diet -unclear androgens
Epidiemology of Acne Vulgaris
very common-nearly every teenager will have it-80% in teens and lot lower later
more common in male adolescent
peak 11-15
in adults-female
Signs and Sx of acne Vulgaris
Classically commences as puberty starts
See/describe-
Non inflammatory -Open comedomes (blackheads) and closed comedones (white heads)
Found escecially in areas with lot of hair
can also see the scarring resulting from acne
Inflammatory -papules, pustules, nodules and cycts
Acne fulminant-abrupt development of nodular and suppurative lesion- can also present with systemic issues-fevers, arthralgia, myalgia
Osteolytic bone lesions suggest Acne fulminant
acne conglobata-erruptive severe noduclarcystic ance, but no systemic showing
Investigations of Acne Vulgaris
its a clinical diagnosis 99% of the times
but if actually need
Free testo can help identify hyperadrogenism
and bacterial cultures If unclear if folliculitis
Management of Acne Vulgaris
depends on severity
General-skin routine-a lot of moisturisers, exfoliants, sunscreen, make up are not amazing
Diet-milk has a clear association
Menstrual/COCP hx -can make better or worse
Masks
Treat fast to avoid makeup
mild/non inflammed-1st line-retinoids (tretinoid), benzolperoxyide,
2nd Line- change around, or salycilic acid (antimicrobial) (less proven efficiency
inflamed Acne-
Abx (clindamycin/erythro) + topical retinoids -should be stopped as soon as improved
dapsone is option as mono therapy but needs long term
topical Benzoyl peroxide-can have side effects but can replace retinoid
azelaic acid can adjunct for reducing hyperpigmentation
Moderate acne -ORAL Abx (tetracycline) and topical retinoid/benzoyl, +BPO limit to 3-6 month 2nd line-change Abx, keep rest same in women, second line is COCP
3rd line-oral retinoid
rest is same
Fulminans -steroids /Severe Acne//acnre sistance to all above ORAL retinoids -(isotretinoid) 6 months 2nd-Oral Abx, topical retinoid, BPO or dapsone
pregnant-difficulty
Complications of Acne vulgaris and treatment
Acne - scarring of the face and disfigurement-loss of confidence
Dyspigmentation
severe acne- can have systematic effects
Retinoids SE-cheilitis, dry mucosa, general xerosis, skin fragility
-can get worse before better
check bloods after 6 months
muscle pain
medication-benzoyl peroxide-can give feels of burning on skin
all the topical stuff can make it feel dry
prognosis of acne vulgaris
Happens in adolescence but often just goes away –most people never see long term consequences
except scarring
and medication causes dryness tends to improve
can get refractory-could be folliculitis, exclude endogenous causes (like drugs)
But also endocrone disorders PCOS,
spirolactone
