Acne vulgaris Flashcards
What is acne?
Acne is a multi-factorial condition in which pilosebaceous units become blocked and inflamed
Where does acne most commonly present?
Face, upper back and anterior chest
Who is most commonly affected by acne?
Peak incidence is during the adolescent stages, with 85% of young people between 12 and 24 being affected
What are some factors that increase risk of acne?
- XYY karyotype
- Polycystic ovarian syndrome
- Hyperandrogenism
- Hypercortisolism
- Precocious puberty
What are some factors that can aggravate acne?
High glycaemic index
Excess dairy consumption
What are some factors that play a role in acne development?
Follicular hyperkeratinisation
Hormonal influences
Inflammation
How does acne form?
Puberty causes increase androgen levels and sensitivity
This causes increased sebum production which plugs the pilosebaceous
Keratin in sebum build up behind the plug, causing bacterial growth and rupturing, leading to acute inflammation and granuloma formation
What is a comodone?
A build up of keratin and sebum behind a pilosebaceous plug
What are the 2 types of comodone?
Open (Blackhead)
Closed (Whitehead)
How do open comodone (Blackheads) form?
Open comodones (Blackheads) occur when the skin covering the sebum plug breaks down, allowing oxidisation of the plug
How do closed comodones (Whiteheads) form?
Closed comodones (Whiteheads) occur when the skin covering the sebum plug remains in tact
What are the 3 grades of acne severity?
Mild
Moderate
Severe
How will mild acne present?
Scattered papules and pustules
How will moderate acne present?
Numerous papules, pustules and mild atrophic scarring
What are some variants of acne vulgaris?
Ance congoblata
Acne fulminans
Ance excoriee
What is acne congoblata?
This is a severe form of nodulocystic acne
Systemic symptoms are usually absent
What is acne fulminans?
Acute, painful, ulcerating, and hemorrhagic clinical form of acne
Systemic symptoms such as fever and polyarthritis may be present
It also may cause bone lesions and laboratory abnormalities
What is acne excoriee?
This most commonly affects young women with an underlying psychiatric disorder
This is a mild acne, including comedones, that are picked and excoriated, leading to scarring
What will biopsy findings show in acne (Usually not required)?
- Dilated follicular opening
- Cellular debris and bacteria
- Leukocytes
- Fragmented hair shafts
- Marked peri-follicular inflammation
How is mild acne usually treated?
Topical treatment only
How is moderate acne treated?
Topical treatment and oral antibiotics or Dianette®(In females)
How is severe acne treated?
Isotretinoin (Roaccutane®)
What are the types of topical treatments available for acne?
Anti-comedonal (C)
Anti-inflammatory (I)
Anti-microbial (M)
What are some examples of topical acne treatments?
- Adapalene (C, I)
- Tretinoin (C)
- Azaleic acid (C, M)
- Nicotinamide (I)
- Benzoyl peroxide (C, M, I)
- Topical anti-biotics (M)
What effects does benzoyl peroxide have in acne?
Benzoyl peroxide is keratolytic, anti-microbial and anti-inflammatory
What are some disadvantages of benzoyl peroxide?
Erythema and peeling and can bleach clothes, hair, bedlinen and towels
What effects do retinoids have in acne?
All retinoids are anti-comedonal, but adapalene is also anti-inflammatory
What are some disadvantages of retinoids?
This can cause stinging, irritation, erythema and peeling
How often should retinoids be used?
At first, it is used every night, however, in cases of side effects, it should be reduced to 2-3x per week
Who should retinoids not be used in?
Pregnant women
When is isotretinoin (Roaccutane) used in acne?
In nodulo-cystic acne and is only used if there is a relapse after antibiotics, if there is significant scarring or if there is severe psychological impairment
How does isotretinoin work?
Reducing sebaceous gland activity
What are some side effects of isotretinoin?
- Dry skin, lips, eyes and nose (Causing nose bleeds)
- Skin fregility
- Hyperlipidaemia
- Abnormal liver function
- Teratogenesis
- Mood alteration (Poor mental health, depression, suicidal ideation)
- Arthralgia
- Acne fulminans
- Hair thinning
- Benign intercranial hypertension (Tetracyclines)
What are some examples of topical antibiotics used in acne?
- Clindamycin
- Tetracycline
- Erythromycin
What are some examples of antibiotic and acne drug combinations?
- Benzamycin (Benzoyl peroxide + Erythromycin)
- Zineryt (Zinc + Erythromycin)
- Isotrexin (Isotretinoin + Erythromycin)
- Aknemycin plus (Tretinoin + Erythromycin)
Why can contraceptives be used in acne treatment?
Anti-androgens such as co-cyprindiol reduce androgen levels and decrease sebum production
