Acne vulgaris

Question 1

How do you manage comedonal acne?

Answer 1

First line: topical retinoid (Adapalene, Isotretinoin) +/- benzoyl peroxide

Question 2

Side effects of topical retinoids?

Answer 2

Will dry the skin and cause local irritation
Avoid in pregnancy

Question 3

Management of mild-moderate Papular/pustular acne

Answer 3

Fixed dose combo treatment of benzoyl peroxide (to reduce bacterial resistance) with either a topic retinoid or topical abx

Question 4

What are the formulations to treat mild-moderate papular/pustular acne?

Answer 4

First line: Epiduo gel (adaplene + benzoyl peroxide)
Second line: Duac gel (clindamycin + BPO)

Question 5

Management of acne that isn’t responding to first line treatments?

Answer 5

Combine systemic abx with a topical agent, preferably BPO or a topical retinoid

First line: tetracycline
Macrolides: clarithromycin, erythromycin- first line in pregnancy and children under 12

In primary care: stop oral abx after 3mnths and can repeat abx course in future if required

Dermatologist: Continue oral abx post 3months if papule/pustules are present

Question 6

Side effects of oral abx?

Answer 6

GI upset, rashes, anaphylaxis, abx associated infections e.g. C.diff, abx resistant, vaginal thrush

Question 7

Side effects for tetracyclines?

Answer 7

Photosensitivity reaction (doxycycline)
Contraindicted if pregnant/breast feeding

Question 8

What is Dianette?

Answer 8

Used by GPs- COC
Treat moderate- severe acne in women
Contraindications same as regular COCP

Question 9

When to refer to secondary care in acne management?

Answer 9

Refer early
Moderate acne only partially responding to treatment and starting to scar/ causing

Patients with associated and severe psychological symptoms, regardless of physical sings

Question 10

Treatment options by a dermatologist for acne?

Answer 10

Oral isotretinoin
high dose oral abx
Dianette with extra cyproteroine acetate (short term)
Short course of steroids

Question 11

What is Isotretinoin?

Answer 11

Roacutane
Retinoid
Closely related to Vit A
Targeting production of sebum and keratin

Question 12

ADRs of retinoids?

Answer 12

Teratogenecity
Mucocutaneous reaction- dry skin, lips and eyes
Fragile skin- cannot wax
Increased risk of skin infection and slower wound healing
Increased sensitivity to the sun
Deranged LFTs
Hypercholesterolaemia
Hypertriglyceridaemia
Myalgia
Arthralgia
Isotretinoin- depression +/- self harm

Question 13

Potential DDIs of retinoids?

Answer 13

Tetracylines
Methotrexate
Vit A supplements
POP

Question 14

Additional requirements of female pts of childbearing age on retinoids?

Answer 14

2 forms of contraception
On pregnancy prevention programme unless opted out

Question 15

Are there any treatments for scarring due to acne?

Answer 15

Treatments outside NHS
NHS able to give steroid injection for keloid scars

Question 16

What is acne?

Answer 16

Inflammatory disease of the pilosebaceous follicle

Question 17

epidemiology of acne vulgaris?

Answer 17

80% of teenagers 13-18 years

Question 18

What are the causes of acne vulgaris?

Answer 18

Hormonal (androgen)

Contributing factors:
- increased sebum production
- abnormal follicular keratinisation
- bacterial colonisation (Propionibacterium acnes)
- inflammation

Question 19

How does mild acne vulgaris present?

Answer 19

• Non inflammatory lesions
• open and closed comedones (black and white heads)

Question 20

How does moderate and sever acne vulgaris present?

Answer 20

• Inflammatory lesions
• papules
• pustules
• nodules
• cysts

Question 21

How does acne vulgaris present in richly pigmented skin?

Answer 21

• Inflammatory lesions may not be so apparent, ‘acne hyperpigmented macules’ are seen
• hyperpigmented lesions cay signify ongoing inflammation
• non-erythematous nodules may be present (feel on palpation)

Question 22

Where does acne vulgaris commonly affect>

Answer 22

Face
chest
upper back

Question 23

What does this show ?

Answer 23

Acne vulgaris
Comedones Left and middle
papules and nodules right