Acne vulgaris

Question 1

cause

Answer 1

multifactorial

Question 2

acne pathogenesis

Answer 2

normal hair follicle has a wide opening

1. narrowing of HF
2. increased sebum production, and increased on skin so feels greasy
3. sebum is blocked in –> stagnates
4. bacterium multiply in stagnant sebum –> irritation + inflammation –> pus formation

Question 3

critical factors in pathological process

Answer 3

• Follicular epidermal hyperproliferation
• Blockage of pilosebaceous units with surrounding inflammation
• Increased sebum production
• Infection with propionibacterium acnes

Question 4

epidemiology

Answer 4

occurs in 85% of adolescents

can continue into early and mid adulthood

Question 5

presentation areas and 3 cardinal signs

Answer 5

face, back, sternal area (where theres lots of sebaceous glands)

1. open comedones (blackheads)
2. closed comedones (whiteheads)
3. pustules

skin may be greasy
premenstrual exacerbation

Question 6

what pathway makes scarring more likely?

Answer 6

rupture of inflamed lesions, deep-seated dermal inflammation + nodulocystic lesions

Question 7

1st line treatment

Answer 7

topical agents

• kertolytics e.g. benzoyl peroxide, azelaic acid
• topical retinoids (tretinoin, isotretinoin)
• topical antibiotics e.g. erythromycin for inflammatory acne

Question 8

side effects of topical agents

Answer 8

irritation

Question 9

2nd line therapy

Answer 9

low-dose oral antibiotics for 3-4 months e.g. oxytetracycline

cyproterone acetate/co-cyprindiol - contraceptive pill that also is anti-androgenic

• UVB phototherapy

Question 10

3rd line therapy

Answer 10

retinoid drug - isotretinoin

Question 11

when to use 3rd line therapy?

Answer 11

if 1st and 2nd line fail
nodulocystic with scarring
severe psychological disturbance

Question 12

caution of 3rd line therapy?

Answer 12

VERY teratogenic

hospital-only drug in most countries