Acne Vulgaris Flashcards
Describe the pathophysiology of acne vulgaris [3]
Increase in Sebum Production:
- Primarily driven by hormonal (particularly testosterone) changes - stimulate sebaceous glands to produce more sebum
Follicular Hyperkeratinisation:
- abnormal keratinocyte proliferation and differentiation within the pilosebaceous unit
- results in the formation of a keratinous plug known as a microcomedo
Colonisation with P. acnes:
- The lipid-rich environment created by increased sebum production also promotes overgrowth of anaerobic bacteria like P. acnes
Describe the clinical manifestatio of acne vulgaris [3]
Comedone Formation
- Closed comedones (whiteheads) occur when the follicular opening is obstructed completely
- Open comedones (blackheads) form when there is partial obstruction with exposure to air causing oxidation of melanin or lipids within the sebum.
Papule and Pustule Development
- inflammation persists around a blocked follicle, it can evolve into papules—small raised bumps indicating underlying inflammation without pus formation.
Nodule and Cyst Formation
Scarring can occur
What type of scars exist in acne valguris? [4]
How do you differentiate acne to rosacea? [2]
Acne have comedones
- open (blackheads)
- closed (whiteheads)
- Scarring common
Rosacea:
- Rosacea often includes symptoms of flushing and ocular involvement which are not seen in acne vulgaris.
- The absence of scarring is more typical for rosacea
Folliculitis is an inflammation of the hair follicles caused by bacterial infection, most commonly Staphylococcus aureus. It can mimic acne vulgaris but there are several distinguishing characteristics.
What are they? [3]
- Folliculitis lesions tend to have a more uniform appearance
- Distribution of folliculitis can occur anywhere there is hair growth (face, chest and back as with acne vulgaris)
- The presence of pruritus (itching) is more common in folliculitis than in acne vulgaris.
Perioral dermatitis presents as small papules and pustules around the mouth area. This condition can be mistaken for acne vulgaris due to similar lesion types; however, it differs which ways?
Limited to the perioral area (around the mouth), periocular area (around the eyes) or nasolabial folds, whereas acne vulgaris commonly affects the face, chest and back.
No comedones
Perioral dermatitis may appear scaly or dry, unlike acne vulgaris.
The following are all treatments used for acne vulgaris.
Describe the effect of each [4]
Topical adapalene
Topical benzoyl peroxide
Topical tretinoin
Topical clindamycin
Topical adapalene:
- a topical retinoid compound with anti-inflammatory effects. It is thought to reduce microcomedone formation.
Topical benzoyl peroxide:
- is a keratolytic medication that also has antibacterial effects. It reduces the amount of the bacteria cutibacterium acnes.
Topical tretinoin:
- has a combination of comedolytic and anti-inflammatory effects. It is also thought to reduce microcomedone formation.
Topical clindamycin:
- is a bacteriostatic antibiotic that is active against cutibacterium acnes. It also has anti-inflammatory properties.
Describe the mangement of mild, moderate and severe acne vulgaris [+]
Mild: 12 week topical combination of any of the following:
* a fixed combination of topical adapalene with topical benzoyl peroxide
* a fixed combination of topical tretinoin with topical clindamycin
* a fixed combination of topical benzoyl peroxide with topical clindamycin
Moderate to severe acne: a 12-week course of one of the following options:
* a fixed combination of topical adapalene with topical benzoyl peroxide
* a fixed combination of topical tretinoin with topical clindamycin
* a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
* a topical azelaic acid + either oral lymecycline or oral doxycycline
Severe - not responding to treament
- Oral isotretinoin (derived from vitamin A and is a powerful anti-inflammatory agent)
NICE guideline 198 (June 2021) advises considering oral isotretinoin use in those over the age of 12 who have failed treatment with topical therapies and systemic antibiotics.
Examples include [4]
Nodulocystic acne
Acne conglobata
Acne fulminans
Acne at risk of permanent scarring
Name a side effect of using tetracylines for acne treatment if used in children under 8 years of age or in pregnant women? [1]
permanent teeth discolouration
What risks occur with isotretinoin prescription? [5]
Teratogenicity
hyperlipidaemia
hepatotoxicity
Sexual side effects: erectile disfunction, loss of libido, vaginal dryness
Photosensitivity
Depression & ? suicide ideation
What monitoring should you perform when prescribing isotretinoin? [3]
Liver function tests
Lipids
Pregnancy tests in female patients
Adult x female with acne, suspect which pathology? [1]
PCOS
Severe cystic acne is called … [[1]
Describe this pathology [1]
Acne conglobate
- rare and severe form of acne characterised by inflammatory nodulocystic disease with interconnecting sinuses and abscesses. It most commonly affects men between the ages of 18 and 30.
Describe what is meant by acne fulminans [1]
Acne fulminans
- severe form of acne conglobata with systemic features such a fever, arthralgia and lymphadenopathy.
- Hospital admission is often required and the condition usually responds to oral steroids
Describe how you treat mild [3], moderate [3] or severe acne [1]
NB can also use: antiandrogens e.g. spironolactone, cyproterone acetate
oral isotretinoin
