Acne Vulgaris

Question 1

What is acne?

Answer 1

Acne is a disease of the pilosebaceous unit.

Question 2

What types of lesions are seen in acne?

Answer 2

Several different types of acne lesions are usually seen in each patient.

Question 3

What are comedones?

Answer 3

Comedones are due to a dilated sebaceous follicle.

Question 4

What forms when the top of a comedone is closed?

Answer 4

If the top is closed, a whitehead is seen.

Question 5

What forms when the top of a comedone is open?

Answer 5

If the top opens, a blackhead forms.

Question 6

What happens when the follicle bursts?

Answer 6

Inflammatory lesions form when the follicle bursts, releasing irritants.

Question 7

What are the types of inflammatory lesions?

Answer 7

The types of inflammatory lesions are papules and pustules.

Question 8

What may result from an excessive inflammatory response?

Answer 8

An excessive inflammatory response may result in nodules and cysts.

Question 9

What can the sequence of events in acne lead to?

Answer 9

This sequence of events can ultimately cause scarring.

Question 10

What are the types of scars caused by acne?

Answer 10

The types of scars are ice-pick scars and hypertrophic scars.

Question 11

What characterizes drug-induced acne?

Answer 11

Drug-induced acne is often monomorphic.

Question 12

What is an example of drug-induced acne?

Answer 12

Pustules are characteristically seen in steroid use.

Question 13

What is acne fulminans?

Answer 13

Acne fulminans is very severe acne associated with systemic upset.

Question 14

What symptoms are associated with acne fulminans?

Answer 14

Symptoms may include fever.

Question 15

What is often required for acne fulminans?

Answer 15

Hospital admission is often required.

Question 16

How does acne fulminans usually respond?

Answer 16

The condition usually responds to oral steroids.

Question 17

What is acne vulgaris?

Answer 17

Acne vulgaris is a common skin disorder that usually occurs in adolescence, affecting the face, neck, and upper trunk, characterized by the obstruction of pilosebaceous follicles with keratin plugs, resulting in comedones, inflammation, and pustules.

Question 18

How is acne vulgaris classified?

Answer 18

Acne vulgaris may be classified into mild, moderate, or severe.

Question 19

What characterizes mild acne?

Answer 19

Mild acne is characterized by open and closed comedones with or without sparse inflammatory lesions.

Question 20

What characterizes moderate acne?

Answer 20

Moderate acne is characterized by widespread non-inflammatory lesions and numerous papules and pustules.

Question 21

What characterizes severe acne?

Answer 21

Severe acne is characterized by extensive inflammatory lesions, which may include nodules, pitting, and scarring.

Question 22

What is the first-line treatment for mild to moderate acne?

Answer 22

A 12-week course of topical combination therapy should be tried first-line, including:
- 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
- Topical benzoyl peroxide may be used as monotherapy if other options are contraindicated.

Question 23

What is the treatment for moderate to severe acne?

Answer 23

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.

Question 24

What are important points about oral antibiotic usage in acne treatment?

Answer 24

Tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years. Erythromycin may be used in pregnancy. Minocycline is less appropriate due to the possibility of irreversible pigmentation. Only continue antibiotic treatment for more than 6 months in exceptional circumstances.

Question 25

What should be co-prescribed with oral antibiotics?

Answer 25

A topical retinoid (if not contraindicated) or benzoyl peroxide should always be co-prescribed with oral antibiotics to reduce the risk of antibiotic resistance developing. Topical and oral antibiotics should not be used in combination.

Question 26

What complication may occur from long-term antibiotic use?

Answer 26

Gram-negative folliculitis may occur as a complication of long-term antibiotic use; high-dose oral trimethoprim is effective if this occurs.

Question 27

What is an alternative to oral antibiotics for women with acne?

Answer 27

Combined oral contraceptives (COCP) are an alternative to oral antibiotics in women and should be used in combination with topical agents.

Question 28

What is the risk associated with Dianette (co-cyprindiol)?

Answer 28

Dianette has anti-androgen properties but carries an increased risk of venous thromboembolism compared to other COCPs, therefore it should generally be used second-line, only for 3 months, and women should be counseled about the risks.

Question 29

What is the recommendation for oral isotretinoin?

Answer 29

Oral isotretinoin should only be used under specialist supervision.

Question 30

What is a contraindication for topical and oral retinoid treatment?

Answer 30

Pregnancy is a contraindication to topical and oral retinoid treatment.

Question 31

What should not be used to treat acne to reduce antibiotic resistance?

Answer 31

The following should not be used:
- Monotherapy with a topical antibiotic
- Monotherapy with an oral antibiotic
- A combination of a topical antibiotic and an oral antibiotic.

Question 32

Who should be referred to a dermatologist?

Answer 32

Patients with acne conglobate, nodulo-cystic acne, or those who have not responded to two completed courses of treatment should be referred.

Question 33

When should referral to a dermatologist be considered?

Answer 33

Referral should be considered if:
- Mild to moderate acne has not responded to two completed courses of treatment
- Moderate to severe acne has not responded to previous treatment that includes an oral antibiotic
- Acne with scarring
- Acne with persistent pigmentary changes
- Acne causing persistent psychological distress or a mental health disorder.

Question 34

What is acne vulgaris?

Answer 34

Acne vulgaris is a common skin disorder that usually occurs in adolescence, affecting the face, neck, and upper trunk.

Question 35

What characterizes acne vulgaris?

Answer 35

It is characterized by the obstruction of the pilosebaceous follicle with keratin plugs, resulting in comedones, inflammation, and pustules.

Question 36

What is the epidemiology of acne vulgaris?

Answer 36

Acne affects around 80-90% of teenagers, with 60% seeking medical advice. It may persist beyond adolescence, affecting 10-15% of females and 5% of males over 25 years old.

Question 37

What are the factors involved in the pathophysiology of acne vulgaris?

Answer 37

The pathophysiology is multifactorial, including follicular epidermal hyperproliferation, obstruction of the pilosebaceous follicle, sebaceous gland activity influenced by androgens, colonization by Propionibacterium acnes, and inflammation.

Question 38

Answer 38

Acne vulgaris - severe with some cysts