acne vulgaris

Question 1

acne - features

Answer 1

face, neck, upper trunk
open/closed comedones
pustules + papules
inflammation

Question 2

acne - pathophys

Answer 2

obstruction of pilosebaceous follicle → comedone
± colonisation by a bacterium
± inflammation around it

follicle bursts → inflammatory lesions → irritants released → pustules + papules

excessive inflammation → nodules + cysts
→ scarring

Question 3

acne - management step up

Answer 3

1 - single topical therapy (retinoid, benzoyl peroxide)
2 - topical combo therapy (abx, benzoyl peroxide, retinoid)
3 - oral abx (oxytetracycline, doxy)
4 - oral isotretinoin
± COCP

Question 4

how to differentiate acne rosacea from vulgaris

Answer 4

rosacea - no comedones, facial flushing

erythema, pustules, inflammatory papules still possible

Question 5

acne - scoring systems

Answer 5

APSEA - assessment of psychological + social effects of acne

LEEDS scoring system to grade it - counts + categorises lesions to inflam + non-inflam

Question 6

acne - lifestyle advice

Answer 6

avoid excessive makeup

skincare:
don't wash >2x daily
mild soap/cleanser + lukewarm water
don't clean blackheads
don't scrub vigorously

for dry skin - fragrance free water based emollient

Question 7

what is mild acne like?

Answer 7

open + closed comedones predominate

± sparse inflammatory lesions (papules + pustules)

Question 8

mild acne - management

Answer 8

either topical retinoid or benzoyl peroxide

± COCP

Question 9

what is moderate acne like?

Answer 9

widespread comedones (non-inflammatory lesions)
numerous papules + pustules

mod risk scarring

Question 10

moderate acne - management

Answer 10

benzoyl peroxide and/or topical retinoid
± COCP
±abx: 
topical erythromycin - 12wk, or
oral tetracycline - back / shoulders / risk scarring

Question 11

what is severe acne like?

Answer 11

extensive papules + pustules (inflammatory lesions)
nodules, cysts, pitting
high risk of scarring

Question 12

severe acne - management

Answer 12

refer derm for isotretinoin. meanwhile:
combo therapy as above - benzoyl, retinoid
oral tetracycline
± COCP

Question 13

difference between inflammatory and non-inflammatory lesions

Answer 13

non-inflammatory type - open or closed comedones - pore blocked with oil where bacteria can thrive

inflammatory - clogged pores are infected with bacteria →
papules (red/tender bumps, ‘pimples that don’t contain pus’)
pustules (papules filled with pus/’pimples that contain pus’)
cysts (‘inflammatory nodules’)
these inflammatory lesions originate from comedones.

bacteria multiply + immune system fights back - affected skin reddens and swells