Acne Vulgaris Flashcards
What is the definition of acne vulgaris?
Disorder of the pilo-sebaceous unit, resulting in blockage of the follicle, formation of comedones and inflammation
What is the aetiology of acne vulgaris?
Age 12-24
Family history
Associated with some endocrine disorders: PCOS, hyperandrogenism
What is the pathophysiology behind acne vulgaris?
- Increased androgens at puberty causing sebum build up
- Hypercornification causes keratin plugging
- Infection with corynebacterium acnes
- Keratin and sebum build up to produce comedones
- Rupture causes acute inflammation and foreign body granulomas - produces the inflammatory lesions
What are the clinical features of acne vulgaris?
Lesions on face, upper back, anterior chest
Non-inflammatory lesions (blackheads and whiteheads)
Inflammatory lesions (papules, pustules, cysts)
Scarring (atrophic, hypertrophic, keloid)
Erythema and hypo/hyperpigmentation
Psychological dysfunction
What is the classification of acne vulgaris?
Mild: scattered comodones, papules and pustules
Moderate: numerous papules, pustules and mild atrophic scarring
Severe: numerous papules, pustules, severe atrophic scarring, cysts, nodules
What are the investigations for acne vulgaris?
Clinical diagnosis
Swabs if uncertain about diagnosis of infectious pustules
Investigations prior to starting isotretinoin
Investigate for endocrine causes eg PCOS
What is the management of mild-moderate acne?
Topical benzoyl peroxide with clindamycin (eg Duac once daily)
Topical retinoids (tretinoin/adapalene)
For 12 weeks then review
Can also consider use of COCP in women
What is the management of moderate-severe acne?
Topical adapalene with benzoyl peroxide and oral lymecycline or doxycycline
OR
Topical azelaic acid with oral lymecycline or doxycycline
For 12 weeks then review
What is the management of severe acne?
Oral antibiotic
Referral for oral isotretinoin (roaccutane)
