Acne Vulgaris Flashcards
What is Acne Vulgaris?
- An inflammatory disease of the pilosebaceous follicle
What are some of the Causes of Acne Vulgaris?
- Hormonal (androgen)
- Increased sebum production
- Abnormal follicular keratinization
- Bacterial Colonization
- Inflammation of the pilosebaceous unit
- Stress
- Cosmetics and Drug Induced
- Steroid use
What is the pilosebaceous unit?
- hair follicle
- hair shaft
- arrector pili muscle
- Sebaceous gland
What is the pathophysiology of Acne Vulgaris?
- Hyperkeratosis - blocking of the pilosebacceous gland increasing sebum production
- Blockage and inflammation of the pilosebaceous units leads to acne vulgaris
What are the clinical features of Non-inflammatory lesions?
- Open and Closed Comedones
- Whiteheads/ Blackheads ( follicles with dilated openings allow oxidisation of follicle content resulting in a black colour)
What are the clinical features of Inflammatory lesions?
- Inflammatory Papules, Pustules, Nodules and Cysts
Which areas does Acne Vulgaris commonly affect?
- Face, Chest and Upper Back
What would you see in richly pigmented skin?
- Inflammatory lesions may not be so apparent, instead may look hyperpigmented
- non- erythematous nodules may be present and detected by palpation
What is Acne Conglobata?
- 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
What is Acne Fulminans?
- A severe form of acne conglobata with systemic features such as a fever, arthralgia and lymphadenopathy
- ulceration and pus discharge
- Investigations: ESR and WCC
What is the classification of Acne for mild to moderate?
1 or more of:
- 2 nodules
- 34 inflammatory lesions
- any non-inflammatory lesions
What is the classification of Acne for moderate to severe?
1 or more of:
- 35 or more inflammatory lesions
- 3 or more nodules
What is the managment for Acne Vulgaris?
- Skincare Advice
- Medical Therapy
- Oral Isotretinoin
- Referral
What is the information on Skincare Advice?
- 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
What is Topical Adapalene?
- A topical retinoid compound with anti-inflammatory effects
- Reduces microcomedone formation
What is Topical Benzoyl Peroxide?
- A keratolytic medication that also has antibacterial effects
- It reduces the amount of the bacteria cutibacterium acnes
What is Topical Tretinoin?
- Has a combination of comedolytic and anti-inflammatory effets
- It also thought to reduce microcomedone formation
What is Oral Tetracyclines?
- Antibiotics that inhibit protein synthesis in bacteria
What is the Managment for mild to moderate Acne?
- 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)
What does the review at 12 weeks for mild to moderate Acne look like ?
- 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
What is the treatment for moderate to severe Acne?
- 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
What is Oral Isotretinoin?
- 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.
When should you consider using Oral Isotretinoin?
- Nodulocystic Acne
- Acne Conglobata
- Acne Fulminans
- Acne at risk of permanent scarring
What are the Complications of Acne Vulgaris?
- Permanent Skin Changes - Hypertrophic and Atrophic Scars, Hypo and Hyperpigmentation may also occur
- Psychological Impact - anxiety, depression and suicide
What are the 4 stages of Acne formation?
What is the significance of Hormonal Acne
- Rekated to menstrual cycle
What are the differential diagnosis for Acne?
- rosacea
- perioral dermatitis
- p follicilits
- gram negative folliculitis
Perioral dermatitis vs Acne ?
- comedones seen
- sparing upper lip areas
Gram negative follicultis ?
- 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
Advice to give to the patient when on isotretinoin?
- 2 weekly bloods
- double contraception - during course, 1 month before or 3 months after the course
- liver disease and cholesterol
What are topical retinoids side effects?
- retinoid dermatitis
- use in sparing amounts
What do you see in steroid induced Acne?
- monomorphic lesions with closed comedones
