Acne Vulgaris

Question 1

Where does acne normally present?

Answer 1

Face
neck
upper trunk

Question 2

How does acne develop? What lesions tend to appear?

Answer 2

obstruction of pilosebaceous follicle with keratin plugs

Sometimes there is colonisation with anaerobic bacterium: Propionibacterium

=> comedones
=> inflammation
=> pustules.

Question 3

When does acne typically occur

Answer 3

Adolescence

May persist with 10-15% females and 5% of males over 25 years old being affected

Question 4

What classifies acne as mild vs moderate vs severe?

Answer 4

MILD: open and closed comedones +/- sparse inflammatory lesions

MODERATE: widespread non-inflammatory lesions and numerous papules and pustules

SEVERE: extensive inflammatory lesions, which may include nodules, pitting, and scarring

Question 5

Describe the 5 main steps in acne treatment

Answer 5

1. single topical therapy (topical retinoids, benzoyl peroxide)
2. Topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
3. oral antibiotics:
   tetracyclines/erythromycin
4. COCP
   - Dianette (co-cyrindiol) for anti-androgen properties
   - used in combination with topical agents
5. oral isotretinoin (Roaccutane)

Question 6

When should tetracycline antibiotics be avoided in acne?

Answer 6

• pregnant or breastfeeding
• children younger than 12 years of age

Question 7

How long should a single oral antibiotic be used to treat acne?

Answer 7

maximum of three months

Question 8

What topical therapy should always be co-prescribed with antibiotics and why?

Answer 8

topical retinoid or benzoyl peroxide
=> reduces risk of antibiotic resistance developing

Question 9

What are the risks of Dianette (co-cyrindiol)? What is the maximum length of time it should be given?

Answer 9

• increased VTE risk compared to other COCPs
• Should only be given for 3 months

Question 10

When is oral isotretinoin contraindicated?

Answer 10

During pregnancy as teratogenic
=> any females on this treatment usually must be on contraception