Acne Vulgaris

Question 1

what is acne vulgaris?

Answer 1

inflammatory disease of the pilosebaceous unit (hair follicle and sebaceous gland)

Question 2

what is the common cutaneous presentation of acne vulgaris?

Answer 2

non-inflammatory lesions
* comedones

inflammatory lesions
* papules
* pustules
* nodules
* cysts
* scarring

Question 3

what is a comedone?

Answer 3

dilated sebaceous follicle in the skin which can be open (blackhead) or closed (whitehead) due to the accumulation of bacterial and cellular debris

Question 4

what is a papule?

Answer 4

solid, raised lesion <0.5cm in diameter

Question 5

what is a pustule?

Answer 5

lesion <0.5cm in diameter that contains pus

Question 6

what is a nodule?

Answer 6

solid, raised lesion <0.5cm in diameter, but with a deeper component

Question 7

what is a cyst?

Answer 7

thin walled closed capsule or sac containing fluid

Question 8

what is the classifcation of mild acne?

Answer 8

presence of non-inflammatory lesions with sparse inflammatory lesions

Question 9

what is the classification of moderate acne?

Answer 9

widespread non-inflammatory lesions with numerous papules and pustules

Question 10

what is the classification of severe acne?

Answer 10

extensive inflammatory lesions including nodules, pitting and scarring

Question 11

what is the aetiology of acne?

Answer 11

• increased sebum production
• increased androgens causing hyperplasia and sebaceous glands
• hyperactive immune response
• bacterial colonisation

Question 12

what is the managment of mild acne?

Answer 12

topical retinoid +/- benzoyl peroxide
OR
topical tretinoin + antibiotic

Question 13

what is the management of moderate acne?

Answer 13

azelaic acid 20% with oral antibiotic
OR
oral anti-androgen (females only)

Question 14

what is the management of severe acne?

Answer 14

oral retinoid

Question 15

how long should topical acne therapies be tried before effects are seen?

Answer 15

2 months

Question 16

what oral antibiotics are used in the management of acne?

Answer 16

tetracyclines:
* doxycyline
* lymecycline

Question 17

when are tetracyclines contraindicated?

Answer 17

pregnancy or breastfeeding

Question 18

what are oral anti-androgens?

Answer 18

• oral contraceptive pill
• spironolactone

Question 19

what should females be counselled about prior to starting oral retinoids?

Answer 19

• highly teratogenic
• contraindicated in pregnancy

pregnancy prevention program = regular tests + at least 1 contraceptive

Question 20

what are the side-effects of oral retinoids?

Answer 20

• dry mucous membranes
• headaches
• hair thinning
• hair loss
• increased risk of suicide and depression
• hepatic impairment

Question 21

what should patients be screened for prior to commencing oral retinoids?

Answer 21

• mental health disorders
• pregnancy