Acne vulgaris

Question 1

What is acne?

Answer 1

Acne is a multi-factorial condition in which pilosebaceous units become blocked and inflamed

Question 2

Where does acne most commonly present?

Answer 2

Face, upper back and anterior chest

Question 3

Who is most commonly affected by acne?

Answer 3

Peak incidence is during the adolescent stages, with 85% of young people between 12 and 24 being affected

Question 4

What are some factors that increase risk of acne?

Answer 4

• XYY karyotype
• Polycystic ovarian syndrome
• Hyperandrogenism
• Hypercortisolism
• Precocious puberty

Question 5

What are some factors that can aggravate acne?

Answer 5

High glycaemic index
Excess dairy consumption

Question 6

What are some factors that play a role in acne development?

Answer 6

Follicular hyperkeratinisation
Hormonal influences
Inflammation

Question 7

How does acne form?

Answer 7

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

Question 8

What is a comodone?

Answer 8

A build up of keratin and sebum behind a pilosebaceous plug

Question 9

What are the 2 types of comodone?

Answer 9

Open (Blackhead)
Closed (Whitehead)

Question 10

How do open comodone (Blackheads) form?

Answer 10

Open comodones (Blackheads) occur when the skin covering the sebum plug breaks down, allowing oxidisation of the plug

Question 11

How do closed comodones (Whiteheads) form?

Answer 11

Closed comodones (Whiteheads) occur when the skin covering the sebum plug remains in tact

Question 12

What are the 3 grades of acne severity?

Answer 12

Mild
Moderate
Severe

Question 13

How will mild acne present?

Answer 13

Scattered papules and pustules

Question 14

How will moderate acne present?

Answer 14

Numerous papules, pustules and mild atrophic scarring

Question 15

What are some variants of acne vulgaris?

Answer 15

Ance congoblata
Acne fulminans
Ance excoriee

Question 16

What is acne congoblata?

Answer 16

This is a severe form of nodulocystic acne

Systemic symptoms are usually absent

Question 17

What is acne fulminans?

Answer 17

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

Question 18

What is acne excoriee?

Answer 18

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

Question 19

What will biopsy findings show in acne (Usually not required)?

Answer 19

• Dilated follicular opening
• Cellular debris and bacteria
• Leukocytes
• Fragmented hair shafts
• Marked peri-follicular inflammation

Question 20

How is mild acne usually treated?

Answer 20

Topical treatment only

Question 21

How is moderate acne treated?

Answer 21

Topical treatment and oral antibiotics or Dianette®(In females)

Question 22

How is severe acne treated?

Answer 22

Isotretinoin (Roaccutane®)

Question 23

What are the types of topical treatments available for acne?

Answer 23

Anti-comedonal (C)
Anti-inflammatory (I)
Anti-microbial (M)

Question 24

What are some examples of topical acne treatments?

Answer 24

• Adapalene (C, I)
• Tretinoin (C)
• Azaleic acid (C, M)
• Nicotinamide (I)
• Benzoyl peroxide (C, M, I)
• Topical anti-biotics (M)

Question 25

What effects does benzoyl peroxide have in acne?

Answer 25

Benzoyl peroxide is keratolytic, anti-microbial and anti-inflammatory

Question 26

What are some disadvantages of benzoyl peroxide?

Answer 26

Erythema and peeling and can bleach clothes, hair, bedlinen and towels

Question 27

What effects do retinoids have in acne?

Answer 27

All retinoids are anti-comedonal, but adapalene is also anti-inflammatory

Question 28

What are some disadvantages of retinoids?

Answer 28

This can cause stinging, irritation, erythema and peeling

Question 29

How often should retinoids be used?

Answer 29

At first, it is used every night, however, in cases of side effects, it should be reduced to 2-3x per week

Question 30

Who should retinoids not be used in?

Answer 30

Pregnant women

Question 31

When is isotretinoin (Roaccutane) used in acne?

Answer 31

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

Question 32

How does isotretinoin work?

Answer 32

Reducing sebaceous gland activity

Question 33

What are some side effects of isotretinoin?

Answer 33

• 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)

Question 34

What are some examples of topical antibiotics used in acne?

Answer 34

• Clindamycin
• Tetracycline
• Erythromycin

Question 35

What are some examples of antibiotic and acne drug combinations?

Answer 35

• Benzamycin (Benzoyl peroxide + Erythromycin)
• Zineryt (Zinc + Erythromycin)
• Isotrexin (Isotretinoin + Erythromycin)
• Aknemycin plus (Tretinoin + Erythromycin)

Question 36

Why can contraceptives be used in acne treatment?

Answer 36

Anti-androgens such as co-cyprindiol reduce androgen levels and decrease sebum production