Acne vulgaris

Question 1

Pathophysiology

Who tends to have this?

Sebum production is increased by androgens which occurs during ….. - 2

Answer 1

Narrow follicles of velds hair
Fine body and facial hair become plugged with hair, sebum and keratinocytes causing comedones.

Teens 13-18 yrs

Pregnancy
PCOS

Question 2

Presentation:

Greasy skin with various types of lesions.

Name of the following:

Comedones:

• Open
• Closed

Inflammatory acne:

• Papules
• Pustules
• Nodules
• Cysts

It effects sebaceous gland-rich areas. Where is this?

Answer 2

Open - blackheads
Closed - whiteheads

Papules = pinheads 
Pustules = pimples 
Nodules = Big papule 
Cysts = when lesions rupture and spread into surrounding dermis 

Face
Upper Back
Chest

Question 3

Ddx

Answer 3

Acne rosacea

Steroid acne

Question 4

Management:

Patient advice

Answer 4

Wash twice a day with mild soap
Do not pick or scrub lesions 
Avoid excessive makeup 
Use an emollient if there is dry skin 
No clear evidence on dietary factors

Question 5

Management:

Anti-androgens:

• What can be given to female patients?
• Diannete - what it contains?
• What diuretic can be used which is step 4 of the HTN management ladder?

Answer 5

Contraceptive pill with oestrogen

Diannete - Oestrogen and anti-androgen cyproterone

Spironolactone

Question 6

Management for mild acne:

Topical therapies - 2

Answer 6

Benzyl peroxide - peeling agents which is antibacterial, anti-inflammatory and comedolytic.

OR

Topical retinoids - comedolytic and anti-inflammatory

Question 7

Management for moderate to severe acne:

Oral therapy

What is another option if they don’t want oral therapies?

Answer 7

Add topical antibiotics - clindamycin or erythromycin - antibacterial and anti-inflammatory effects
4-6 months

Combine benzyl peroxide and topical retinoids

Question 8

Management for severe acne:

You are using it for scalp

Answer 8

Oral retinoids - isotretinoin

Question 9

Oral antibiotics

Indications

Examples

What should it be used in combination with?

Length of Rx

Answer 9

Moderate acne - pustules and papules

Tetracycline
Doxycycline
Erythromycin

Topical agents - benzyl or isotretinoin

3-6 months

Question 10

Oral isotretinoin:

Indications

MOA

Side effects

What should be avoided?

Answer 10

Severe acne - nodules and cysts

Reduces sebum production

Dry skin and lips

Teratogenicity, depression