Acne Vulgaris

Question 1

What is Acne Vulgaris?

Answer 1

Chronic inflammation in pockets within the skin known as pilosebaceous units (PSUs).

Question 2

What is a PSU?

Answer 2

Tiny dimples in the skin that contain hair follicles and sebaceous glands (which produce natural skin oils and sebum).

Question 3

Pathophysiology of Acne.

Answer 3

1. Increased Production of Sebum.
2. Trapping of Keratin (Dead Cells).
3. Blockage of PSU.
4. Swelling and Inflammation - Comedone (Inflamed Unit).

Question 4

Why is Acne exacerbated by Puberty and relieved by Contraception?

Answer 4

Androgenic hormones increase the production of Sebum.

Question 5

What bacteria has an important role in Acne?

Answer 5

Propionibacterium acnes - bacterium that colonises the skin (excessive growth exacerbates acne).

Question 6

Management of Acne (7).

Answer 6

1. Conservative.
2. Topical Benzoyl Peroxide.
3. Topical Retinoids.
4. Topical Antibiotics e.g. Clindamycin.
5. Oral Antibiotics e.g. Lymecycline.
6. OCP - Dianette.
7. Oral Retinoids (Last Line).

Question 7

How does Topical Benzoyl Peroxide work?

Answer 7

1. Reduces inflammation.
2. Unblocks skin.
3. Toxic to P. acnes bacteria.

Question 8

How do Topical Retinoids work?

Answer 8

1. Chemicals related to Vitamin A.

2. Slow production of Sebum.

Question 9

Importance of Retinoids.

Answer 9

TERATOGENIC.

Question 10

What is Roaccutane?

Answer 10

Oral Isotretinoin - very effective Retinoid but strongly teratogenic.

Question 11

Adverse Effects of Roaccutane.

Answer 11

1. Dry Skin and Lips.
2. Photosensitivity to Sunlight.
3. Suicidal Ideation and Mental Health.
4. Rarely : Drug Induced Epidermal Necrosis.

Question 12

Importance of Tetracyclines.

Answer 12

Avoid if pregnant or breastfeeding and kids below 12.

Question 13

Why should Benzoyl Peroxide be prescribed with a Topic Retinoid?

Answer 13

Reduce risk of antibiotic resistance.