Acne vulgaris Flashcards
What is it
obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.
What is the cause
follicular epidermal hyperproliferation resulting in the formation of a keratin plug. This in turn causes obstruction of the pilosebaceous follicle. Activity of sebaceous glands may be controlled by androgen, although levels are often normal in patients with acne
What is seen in patients
Different types of lesions are seen
What can cause colonisation
colonisation by the anaerobic bacterium Propionibacterium acnes
What do inflammatory lesions form and when
Inflammatory lesions form when the follicle bursts releasing irritants
papules
pustules
An excessive inflammatory response may result in:
nodules
cysts
What can it lead to
This sequence of events can ultimately cause scarring
ice-pick scars
hypertrophic scars
What happens in steroid induced acne
drug-induced acne is often monomorphic (e.g. pustules are characteristically seen in steroid use)
What happens in acne fulminans
very severe acne associated with systemic upset (e.g. fever). Hospital admission is often required and the condition usually responds to oral steroids
When does it occur
Adolescence
What can is mild acne
open and closed comedones with or without sparse inflammatory lesions
What is Moderate
widespread non-inflammatory lesions and numerous papules and pustules
What is severe
extensive inflammatory lesions, which may include nodules, pitting, and scarring
What advice should be given
To avoid over-cleaning the skin (which may cause dryness and irritation). Acne is not caused by poor hygiene.
To use a non-alkaline (skin pH neutral or slightly acidic) synthetic detergent cleansing product twice daily on acne-prone skin.
To avoid oil-based comedogenic skin care products, make-up and sunscreens, and if make-up is used it should be removed at the end of the day.
That persistent picking or scratching of lesions can increase the risk of scarring.
That treatments may irritate the skin, especially at the start of treatment.
To reduce the risk of skin irritation associated with topical treatments, start with alternate-day or short-contact application (for example washing off after an hour).
What is the 1st line
single topical therapy (topical retinoids, benzoyl peroxide)
2nd line
topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
What antibiotics
tetracyclines: lymecycline, oxytetracycline, doxycycline
What should be used in pregnancy
tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age
erythromycin may be used in pregnancy
What is contraindicated with pregnancy
topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning a pregnancy.
Which tetracycline should not be used
minocycline - pigmentation irreversable
How long should abx be used
Max 3 months
What should be given alongside abx
topical retinoids or benzoyl peroxide to reduce abx resistance
What should you never do
Topical + oral abx
What can happen as a result of long term abx use
Gram-negative folliculitis