Acne vulgaris

Question 1

Types of lesions in acne vulgaris

Answer 1

• comedones (whitehead, blackhead)
• papules and pustules
• nodules and cysts

Question 2

drug-induced acne

Answer 2

• often monomorphic
• example includes pustules caused by steroid use

Question 3

Acne fulminans

Answer 3

• very severe acne associated with systemic upset (e.g. fever)
• hospital admission often required
• usually responds well to oral steroids

Question 4

Acne vulgaris

Answer 4

• common skin disorder
• usually occurs in adolescence
• typically affects face, neck, upper trunk
• characterised by obstruction of pilosebaceous follicles with keratin plugs

Question 5

Mild acne

Answer 5

• open and closed comedones
• with/without sparse inflammatory lesions

Question 6

Moderate acne

Answer 6

• widespread non-inflammatory lesions
• numerous papules and pustules

Question 7

Severe acne

Answer 7

• extensive inflammatory lesions
• may include nodules, pitting, scarring

Question 8

Management of moderate acne

Answer 8

12 week course of topical combination therapy with…
- topical adapalene
- topical benzoyl peroxide
- topical tretinoin
- topical clindamycin

Question 9

Management of moderate-severe acne

Answer 9

• 12 week course of combination therapy
• COCP (alt. in women)
• oral isotretinoin (pregnancy is CA!!)

Question 10

Preventing antibiotic resistance in acne vulgaris treatment

Answer 10

avoid:
- monotherapy with topical antibiotic
- monotherapy with oral antibiotic
- comination of topical and oral antibiotics

Question 11

NICE referral criteria in acne vulgaris

Answer 11

always refer:
- conglobate acne (severe, men, form sinuses and cysts)
- nodulo-cystic acne

consider refer:
- mild-moderate not responded two completed treatment courses
- moderate-severe not responded to treatment including oral antibiotic
- acne with scarring
- acne with persistent pigmentary changes
- acne causing persistent psychological distress etc.

Question 12

Pathophysiology of acne vulgaris

Answer 12

multifactorial physiology
- follicular epidermal hyperproloferation -> keratin plug -> blocked pilosebacoeous follicle
- colonisation by anaerobic bacteria Proprionibacterium acnes
- inflammation

Question 13

Retinoids

Answer 13

• e.g. isotretinoin (oral)
• treatment of severe acne

Question 14

Adverse effects of retinoids

Answer 14

• teratogenic
• dry skin, eyes, lips, mouth
• low mood
• raised triglycerides (hyperlipidaemia)
• hair thinning
• nose bleeds
• intracranial hypertension
• photosensitivity