Acne vulgaris

Question 1

obstruction of the […] follicle with […] plugs which results in […], inflammation and pustules.

Answer 1

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

Question 2

colonisation by the anaerobic bacterium […] […]

Answer 2

Propionibacterium acnes

Question 3

Acne vulgaris

mild: […] and […] comedones with or without sparse inflammatory lesions

moderate acne: widespread non-inflammatory lesions and numerous […] and […]

severe acne: extensive inflammatory lesions, which may include nodules, […], and […]

Answer 3

mild: open and closed comedones with or without sparse inflammatory lesions
moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring

Question 4

Acne vulgaris mx

1st step - single […] therapy (topical […], […] […])

2nd step topical combination therapy (topical […] + benzoyl peroxide, topical retinoid)

3rd step: […] antibiotics:
[…]: lymecycline, oxytetracycline, doxycycline
[…] should be avoided in […] or […] women and in children younger than […] years of age
[…] may be used in pregnancy

• […] […] […] ([…]) are an alternative to oral antibiotics in women

oral […]: only under specialist supervision

Answer 4

Acne vulgaris mx

1st step - single topical therapy (topical retinoids, benzoyl peroxide)

2nd step topical combination therapy (topical antibiotic + benzoyl peroxide, topical retinoid)

3rd step: oral antibiotics:
tetracyclines: lymecycline, oxytetracycline, doxycycline
tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age
erythromycin may be used in pregnancy

• combined oral contraceptives (COCP) are an alternative to oral antibiotics in women

oral isotretinoin: only under specialist supervision

Question 5

Adverse effects of oral isotretinoin

1. […] - females should ideally be using […] forms of contraception (e.g. Combined oral contraceptive pill and condoms)
2. dry skin, eyes and lips/mouth
3. […] mood
4. raised triglycerides
5. hair thinning
6. nose bleeds (caused by dryness of the nasal mucosa)
7. intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
8. photosensitivity

Answer 5

teratogenicity
females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips/mouth
the most common side-effect of isotretinoin
low mood
whilst this is a controversial topic, depression and other psychiatric problems are listed in the BNF
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity