Acne Vulgaris

Question 1

Where does the rash from acne vulgaris typically affect?

Answer 1

Face
Trunk

(corresponds to higher expression of sebaceous glands)

Question 2

What is the rash from acne vulgaris composed of?

Answer 2

Comedones
Pustules/papules
Erythema
Scarring

Question 3

What types of scarring are there in acne vulgaris?

Answer 3

Atrophic
Hypertrophic
Ice-pick

Question 4

What is the pathogenesis of acne vulgaris?

Answer 4

1. During puberty, there is increased androgen production
2. Androgen acts on sebaceous glands to make them hypersecrete sebum
3. This blocks the pilo-sebaceous unit which eventually ruptures
4. The rupture causes inflammation and infection which is responsible for the characteristic rash

Question 5

What bacterium commonly infects the skin in acne vulgaris?

Answer 5

Corynebacterium acnes

Question 6

What are the severities of acne vulgaris?

Answer 6

Mild (comedones)

Moderate (numerous pustules/papules)

Severe (significant scarring)

Question 7

What are the topical treatment options for acne vulgaris and how do they work?

Answer 7

Benzoyl peroxide (keratolytic with anti-inflammatory properties)

Topical vitamin A derivative/retinoid (unblock the pilo-sebaceous unit)

Doxycycline (antibiotic active against c. acnes with anti-inflammatory effect)

Question 8

What are the oral treatment options for acne vulgaris and how do they work?

Answer 8

Doxycycline (antibiotic active against c. acnes with anti-inflammatory effect)

Isotretinoin (potent retinoid which disrupts sebum production)

Question 9

What are the side effects of isotretinoin?

Answer 9

Initial aggrevation of acne
Dry skin
Teratogenic
Hepatotoxic
Depression

Question 10

What acne vulgaris treatment is delayed in its effects and for how long?

Answer 10

Doxycycline

Takes 6 months to have an effect