Acne vulgaris

Question 1

Causes of acne vulgaris

Answer 1

1. genetics (Fhx.)
2. hormones (androgens)
3. age (adolescence)
4. external factors (stress, diet, pollutants)

Question 2

Pathophysiology of acne vulgaris

Answer 2

1. increased sebum production
2. follicular hyperkeratinisation
3. (sometimes colonisation with P. acnes bacterium)

Question 3

Clinical features of acne vulgaris

Answer 3

• open & closed comedones
• papules & pustules
• nodules & cysts
• scarring (ice pick, hypertrophic)

Question 4

Differentials for acne vulgaris

Answer 4

1. rosacea
2. folliculitis
3. perioral dermatitis

Question 5

Defining Mild, Moderate & Severe acne

Answer 5

Mild:
- comedones
- sparse inflammaiton

Moderate:
- non-inflamed lesions
- papules and pustules

Severe:
- extensive inflammation
- nodules and cysts
- pitting and scarring

Question 6

Managing mild-moderate acne vulgaris

Answer 6

12 weeks of topical combination therapy
- adapalene + benzoyl peroxide
- tretintoin + clindamycin
- benzoyl peroxide + clindamycin

Question 7

Topical treatments for mild-moderate acne vulgaris

Answer 7

1. topical benzoyl peroxide
2. topical adapalene
3. topical tretintoin
4. topical clindamycin

Question 8

Managing moderate-severe acne vulgaris

Answer 8

1. 12 week course (mixed topical + oral therapies)
2. oral combined contraceptive pill (as combo, in place of ab)
3. specialist referral - oral isotretinoin

Question 9

Topical & oral therapies used for moderate-severe acne

Answer 9

• topical adapalene
• topical benzoyl peroxide
• topical azeliac acid
• topical clindamycin
• oral lymecycline
• oral doxycycline
• oral isoretinoin

Question 10

Specialist referral criteria for acne vulgaris

Answer 10

1. acne conglobata
2. nodular-cystic acne
3. mental health issues
4. acne with scarring
5. mild acne not improving with x2 courses of treatment
6. moderate acne not improving with x1 course of treatment