Acne Vulgaris/Common Acne Flashcards
Clinical Feature
a common inflammatory pilosebaceous disease categorized with respect to severity
Type I:
comedonal, sparse, no scarring
Type II:
comedonal, papular, moderate ± little scarring
Type III
comedonal, papular, and pustular, with scarring
Type IV:
nodulocystic acne, risk of severe scarring
sites of predilection
face, neck, upper chest, and back
Pathophysiology of the lesion
hyperkeratinization at the follicular ostia (opening) blocks the secretion of sebum leading to the
formation of microcomedones
Hormones Pathophysiology
androgens promote excess sebum production
Pathophysiology Bacteria
Cutibacterium acnes metabolize sebum to free fatty acids and produces pro-inammatory mediators
Epidemiology Age of onset
in puberty (10-17 yr in females, 14-19 yr in males)
in prepubertal children consider
underlying hormonal abnormality (e.g. late onset congenital adrenal
hyperplasia)
incidence
decreases in adulthood
genetic predisposition
majority of individuals with cystic acne have parent(s) with history of severe
acne
Differential Diagnosis
folliculitis, keratosis pilaris (upper arms, face, thighs), perioral dermatitis, rosacea
Management MILD ACNE:
Topical Therapies OTC.
Benzoyl peroxide (BPO)
Salicylic acid
Salicylic acid
Used when patients cannot tolerate a topical retinoid
due to skin irritation
Benzoyl peroxide (BPO)
Helps prevent C. acnes resistance, is a bactericidal
agent (targets P. acnes) and is comedolytic
Management MILD ACNE
Prescription Topical Therapies
Antimicrobials
Retinoids
Combination products
Antimicrobials
Clindamycin (Dalacin T), Erythromycin
High rate of resistance when used as monotherapy
Retinoids
Vitamin A Acid (Tretinoin, Stieva-A,
Retin A), Adapalene (Differin)
Backbone of topical acne therapy
All regimens should include a retinoid unless patient
cannot tolerate
Combination products
Clindoxyl (Clindamycin and BPO) Benzaclin (Clindamycin and BPO) TactuPump (Adapalene and BPO) Biacna (Clindamycin and Tretinoin) Benzamycine (BPO and Erythromycin
Combination products Function
Allows for greater adherence and efficacy
Combines different mechanisms of action to increase
efficacy and maximize tolerability
Management MODERATE ACNE
Tetracycline/Minocycline/Doxycycline
Cyproterone acetate-ethinyl estradiol
Spironolactone
Tetracycline/Minocycline/
Doxycycline
Use caution with regard to drug interactions: do not use
with isotretinoin
Sun sensitivity
Antibiotics require 3 mo of use before assessing efficacy
Cyproterone acetate-ethinyl
estradiol
Diane-35®
After 35 yr of age, estrogen/progesterone should only be considered in exceptional circumstances, carefully
weighing the risk/benefit ratio with physician guidance
Spironolactone
May cause hyperkalemia if concurrent renal dx
Black box warning for breast cancer
SEVERE ACNE management
Isotretinoin
Isotretinoin.
Side Effects, courses.
Tests
Most adverse effects are temporary and will resolve when the drug is discontinued
Baseline lipid profile (risk of hypertriglyceridemia), LFTs and β-hCG before treatment
May transiently exacerbate acne before patient sees
improvement
Refractory cases may require multiple courses of
isotretinoin
Treatment of Acne Scars
Tretinoin creams • Glycolic acid • Chemical peels for superficial scars • Injectable fillers (collagen, hyaluronic acid) for pitted scars • Fraxel laser • CO2 laser resurfacing
Blackheads (comedones) are black
because of
oxidized fatty acids, not dirt
Acne Exacerbating Factors
• Systemic medications:
lithium, phenytoin,
steroids, halogens, androgens, iodides,
bromides, danazol
Acne Exacerbating Factors Topical agents:
steroids, tars, ointments,
oily cosmetics
