Acne Vulgaris Flashcards
What is the pathophysiology of ACNE?
First there is accumulation of keratin and thick sebum which blocks the sebaceous gland. Androgenic activity can increase sebum production and viscosity. Propionibacterum acnes proliferates around sebum and causes mild inflammation. Then there is marked inflammation and subsequent scarring.
What are the clinical features of Acne?
3 main features for diagnosis are: Papules, pustules and comedones. Other features which may be present are erythema, nodules, cysts and scarring. In darker skin this may present as hyperpigmentation.
Distribution is usually face, chest, back and occasionally legs/scalp.
What are the subtypes of acne?
Papulopustular,
Nodulocystic,
Comdeonal,
Steroid induced,
Acne fulminans (severe, presents suddenly with haemorrhage and ulceration)
Acne rosacea
Hidradenitis (affects apocrine glands of axilla/groin)
What does the following image show?
Acne fulminans. It is very severe acne which is associated with systemic upset (fever). Requires hospital admission and usually responds to steroids
How do you classify the severity of acne?
Mild - Open and closed comedones +/- sparse inflammatory lesions.
Moderate - widespread non inflammatory lesions with numerous papules and pustules.
Severe acne - Extensive inflammatory lesions which may include nodules, pitting and scarring
What is the management of mild to moderate acne?
1st line = 12 week course of:
* topical adapalene and benzyl peroxide or
* tropical tretinoin and topical clindamycin or
* topical benzyl peroxide and topical clindamycin.
What is the management of moderate to severe acne?
12 week course of one of following:
* Topical adapalene with benzyl peroxide,
* Topical tretinoin with topical clindamycin,
* Topical adapalene with benzyl peroxide and oral lymecycline/doxycycline
* Topical azelaic acid and oral lymecycline/doxycycline
What antibiotic can be used in pregnancy for acne?
Erythromycin
What are some oral non antibiotic treatments for moderate to severe acne?
Combined oral contraceptive pill - Co-cyprindiol (increased risk of VTE so only give for 3 months)
Oral isotretinoin - women require two forms of contraception and monthly negative pregnancy tests. Side effects include dry lips, nose bleeds, dry skin, derranged LFTs.
How do you reduce antibiotic resistance in the treatment of acne?
Avoid monotherapy of antibiotics and avoid giving oral and topical antibiotics
What are some of the potential side effects of acne treatments?
Topical agents can cause irritation, burning, peeling or bleaching. Oral abx can cause gastrointestinal upset. The OCP can increase DVT risk.
Which acne patients should get referred to dermatology?
All patients with acne conglobate or patients with nodulo-cystic acne.
Consider - mild/mod acne which hasn’t responded to two courses of treatment. Severe acne which hasn’t responded to treatment of oral antibiotic, acne with scarring or pigment changes or acne causing psychological distress.
What is Hidradenitis suppurative?
Chronic painful, inflammatory skin condition which has nodules, pustules, sinus tracts and scars. Most commonly occurs at the axilla.
Acute flares are treated with steroids or fluclox. Long term disease can be treated with topical or oral antibiotics
