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Dermatology > Acne Vulgaris > Flashcards

Acne Vulgaris Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Acne Vulgaris?

A
  • An inflammatory disease of the pilosebaceous follicle
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2
Q

What are some of the Causes of Acne Vulgaris?

A
  • Hormonal (androgen)
  • Increased sebum production
  • Abnormal follicular keratinization
  • Bacterial Colonization
  • Inflammation of the pilosebaceous unit
  • Stress
  • Cosmetics and Drug Induced
  • Steroid use
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3
Q

What is the pilosebaceous unit?

A
  • hair follicle
  • hair shaft
  • arrector pili muscle
  • Sebaceous gland
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4
Q

What is the pathophysiology of Acne Vulgaris?

A
  • Hyperkeratosis - blocking of the pilosebacceous gland increasing sebum production
  • Blockage and inflammation of the pilosebaceous units leads to acne vulgaris
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5
Q

What are the clinical features of Non-inflammatory lesions?

A
  • Open and Closed Comedones
  • Whiteheads/ Blackheads ( follicles with dilated openings allow oxidisation of follicle content resulting in a black colour)
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6
Q

What are the clinical features of Inflammatory lesions?

A
  • Inflammatory Papules, Pustules, Nodules and Cysts
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7
Q

Which areas does Acne Vulgaris commonly affect?

A
  • Face, Chest and Upper Back
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8
Q

What would you see in richly pigmented skin?

A
  • Inflammatory lesions may not be so apparent, instead may look hyperpigmented
  • non- erythematous nodules may be present and detected by palpation
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9
Q

What is Acne Conglobata?

A
  • A rare and severe form of acne characterised by inflammatory nodulocystic disease with interconnecting sinuses and abscesses
  • Severe scarring
  • On the trunk
  • Development due to:
    1. bacteria cutibacterium acnes
    2. results from steroid use/ abuse
    3. androgen-producing tumours
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10
Q

What is Acne Fulminans?

A
  • A severe form of acne conglobata with systemic features such as a fever, arthralgia and lymphadenopathy
  • ulceration and pus discharge
  • Investigations: ESR and WCC
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11
Q

What is the classification of Acne for mild to moderate?

A

1 or more of:
- 2 nodules
- 34 inflammatory lesions
- any non-inflammatory lesions

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12
Q

What is the classification of Acne for moderate to severe?

A

1 or more of:
- 35 or more inflammatory lesions
- 3 or more nodules

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13
Q

What is the managment for Acne Vulgaris?

A
  • Skincare Advice
  • Medical Therapy
  • Oral Isotretinoin
  • Referral
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14
Q

What is the information on Skincare Advice?

A
  • Advise people with acne to use non-alkaline synthetic detergent cleansing product twice daily on acne-prone skin
  • Advise people with acne who use skincare products and sunscreens to avoid oil-based and comedogenic preparations
  • Advise people with acne who use make-up to avoid oil-based comedogenic products
  • Advise people to remove make-up at the end of the day
  • Advise patients not to pick or scratch their acne lesions
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15
Q

What is Topical Adapalene?

A
  • A topical retinoid compound with anti-inflammatory effects
  • Reduces microcomedone formation
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16
Q

What is Topical Benzoyl Peroxide?

A
  • A keratolytic medication that also has antibacterial effects
  • It reduces the amount of the bacteria cutibacterium acnes
17
Q

What is Topical Tretinoin?

A
  • Has a combination of comedolytic and anti-inflammatory effets
  • It also thought to reduce microcomedone formation
18
Q

What is Oral Tetracyclines?

A
  • Antibiotics that inhibit protein synthesis in bacteria
19
Q

What is the Managment for mild to moderate Acne?

A
  • Topical adapalene with topical benzoyl peroxide (cannot be used in pregnancy, caution in breastfeeding, skin irritation, burning sensation, bleaching of hair and clothes, photosensitivity)
  • Topical tretinoin with topical clindamycin (cannot be used in pregnancy or in breastfeeding, skin irritation and photosensitivity)
  • Topical benzoyl peroxide with topical clindamycin ( skin irritation, burning sensation, bleaching and photosensitivity)
20
Q

What does the review at 12 weeks for mild to moderate Acne look like ?

A
  • Completely cleared = consider maintenance options
  • Inadequate response = offer another treatment option from mild to moderate for 12 weeks
  • Not responded to 2 courses of treatment = offer first line treatment from moderate to severe
21
Q

What is the treatment for moderate to severe Acne?

A
  • Topical Adapalene and Benzoyl Peroxide + oral antibiotic
  • Topical Azelaic acid plus oral antibiotic

1st line: oral lymecycline 408mg
2nd line: oral doxycycline 100mg

Erythromycin for Pregnant women

22
Q

What is Oral Isotretinoin?

A
  • Isotretinoin is derived from Vitamin A and is a powerful anti-inflammatory agent.
  • It decrease sebum release and reduces bacteria in the skin
  • Only reserved for those with severe disease not responding to treatment and acne that is at a risk of causing permanent scarring.
23
Q

When should you consider using Oral Isotretinoin?

A
  • Nodulocystic Acne
  • Acne Conglobata
  • Acne Fulminans
  • Acne at risk of permanent scarring
24
Q

What are the Complications of Acne Vulgaris?

A
  • Permanent Skin Changes - Hypertrophic and Atrophic Scars, Hypo and Hyperpigmentation may also occur
  • Psychological Impact - anxiety, depression and suicide
25
Q

What are the 4 stages of Acne formation?

A
26
Q

What is the significance of Hormonal Acne

A
  • Rekated to menstrual cycle
27
Q

What are the differential diagnosis for Acne?

A
  • rosacea
  • perioral dermatitis
  • p follicilits
  • gram negative folliculitis
28
Q

Perioral dermatitis vs Acne ?

A
  • comedones seen
  • sparing upper lip areas
29
Q

Gram negative follicultis ?

A
  • long term antibiotic use and develop pustular lesions
  • when they are taken off the antibiotics they do not improve
  • no comedones only pustules
  • swab shows gram negative bacteria
30
Q

Advice to give to the patient when on isotretinoin?

A
  • 2 weekly bloods
  • double contraception - during course, 1 month before or 3 months after the course
  • liver disease and cholesterol
31
Q

What are topical retinoids side effects?

A
  • retinoid dermatitis
  • use in sparing amounts
32
Q

What do you see in steroid induced Acne?

A
  • monomorphic lesions with closed comedones

Dermatology (32 decks)

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