Acne Vulgaris

Question 1

Define acne vulgaris

Answer 1

Inflammatory disease of the pilosebaceous unit

Question 2

Aetiology of acne vulgaris

Answer 2

Thought to becausedby the interaction of multiple factors, including:

Increased sebum production

Increased androgens causing hyperplasia of sebaceous glands

Hyperactive immune response

Bacterial colonisation

Question 3

Clinical features of acne vulgaris

Answer 3

Typically affects face, neck and upper trunk

Characterised by the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules

Ice-pick scars

Hypertrophic scars

Question 4

Describe the appearance of mild acne vulgaris

Answer 4

Open and closed comedones with or without sparse inflammatory lesions

Question 5

Describe the appearance of moderate acne vulgaris

Answer 5

Widespread non-inflammatory lesions and numerous papules and pustule

Question 6

Describe the appearance of severe acne vulgaris

Answer 6

Extensive inflammatory lesions, which may include nodules, pitting, and scarring

Question 7

Management of acne vulgaris

Answer 7

1st line (mild) = topical retinoid with/out Benzoyl Peroxide OR topical antibiotic OR Azelaic acid 20%

2nd line (moderate) = oral antibiotic or oral anti-androgen (females only)

3rd line (severe) = oral retinoid

Topical therapies should be used for ~2 months for an effect to be seen

Oral antibiotics used are tetracyclines - avoid in breastfeeding or <12

Oral retinoids contraindicated during pregnancy as teratogenic (commonly prescribed OCP at same time)

Question 8

Complications of acne vulgaris

Answer 8

Post inflammatory hyperpigmentation

Scarring

Deformity

Psychological and social effects