Acneiform Eruptions Flashcards
What is the pathophysiology of Acne Vulgaris?
- A chronic inflammatory skin disease of the PSU
- “sticky keratinocytes”
- increased sebum viscosity
- blocked follicles = comedones
- > closed comedone = “white head”
- > open comedone = “black head”
- change in commensal bacterial behaviour (Propionobacterium Acnes = opportunistic pathogen)
- papules, nodules, cysts, scars
What are the causes of Acne?
- Hormonal:
- > androgen
- Contributing factors:
- > increased sebum production
- > abnormal follicular keratinisation
- > bacterial colonisation (Propionibacterium Acnes)
- > inflammation
What are the identifying clinical features of Acne Vulgaris?
- Commonly affects the face, chest and upper back
- Mild Acne: Non-inflammatory lesions (blackheads + whiteheads = blocked follicles)
- Moderate + Severe Acne: Inflammatory lesions (papules, pustules, nodules and cysts)
What are the clinical subtypes of Acne Vulgaris?
- Comedonal Acne
- Papulopustular Acne
- Nodular Cystic Acne
- Acne Fulminans
What is the treatment of mild acne?
- Benzoyl Peroxide
- Topical Abx
- Topical Retinoids
What is the treatment of moderate-severe acne?
- Oral abx
- Combined OCP (females) - anti-androgens
What is the treatment of severe acne?
- Oral retinoids -> Roaccutane (Isotretinoin)
What is the treatment of Acne Fulminans?
- cover with Pred
- start low-dose Isotretinoin (roaccutane)
What is the clinical presentation of Acne Fulminans?
- Sudden onset Acneiform eruption
- feverish and unwell, joint pains
What are the main side-effects of Isotretinoin?
only prescribed by Dermatologists in hospital
- Teratogenic
- > pregnancy prevention programme - double-method of contraception
- Risk of low mood
- > counselling required prior to treatment
- Can raise triglycerides
- Others: drying out of mucous membranes, reduction in night vision, photosensitivity, myalgia, headaches
When is Isotretinoin (Roaccutane) indicated?
- Treatment failure
- Evidence of Scarring
- Severe Acne
- Acne Fulminans
What are the identifying clinical features of Acne Rosacea?
- Females
- Fair-skinned/Celts
- Flushing (alcohol, spices, emotion, hot drinks)
- “Sensitive” skin
- Lesions:
- > “ace-of-clubs” distribution (forehead and cheeks bilaterally)
- > Unusual on non-facial sites
- > NO COMEDONES (blocked follicles)
What are the clinical subtypes of Acne Rosacea?
- Erythemato-telangiectatic
- Papulo-pustular (nb. NO COMEDONES)
- Phymatous (M»>F)
- Ocular
What is the treatment of mild rosacea?
- Topical Metronidazole
- Topical Azeliac acid
What is the treatment of moderate-severe rosacea?
- oral Abx (particularly doxyxycline)
- low-dose Isotretinoin
- Light-based treatments
- Laser
