Acneiform Eruptions Flashcards
What portion of the body is affected by chronic inflammation in acne vulgaris?
Chronic inflammation of the pilo-sebaceous unit - affects the face, chest and the back
How does sebum excretion rate change in acne?
There is increased sebum excretion rate
Sebum excretion rate increases at puberty
What are the two types of comedones?
Open comedones (blackheads)
Closed comedones (whiteheads)
What are blackheads?
Dilated keratin filled follicles which appear as black papules due to the keratin debris
What are whiteheads?
Accumulation of sebum and keratin deeper in the pilosebaceous ducts
How does inflammation occur in acne?
Pilosebaceous duct becomes blocked, following this there is bacterial colonisation of the duct which causes the release of inflammatory mediators
What can arise from comedones?
Inflammatory papules, nodules and cysts
What is the most common peak of acne vulgaris?
15 - 18 years (incidence as high as 90%)
Is there a genetic component to acne?
Yes, there may be a positive family history
What colonises the pilosebaceous ducts?
Propionibacterium
Causes inflammation, hypercornification and occlusion of pilosebaceous ducts
Cornification - when squamous epithelium develops into tough protective layers
What is the TOPICAL treatment for acne vulgaris?
- retinoids
- benzoyl peroxide (BPO)
- anti-biotics : clindamycin
tetracycline
erythromycin
•others
What is the NON-TOPICAL treatment for acne vulgaris?
•anti-biotics : tetracyclines
erythromycin
(trimethoprim)
- anti-androgens : oral contraceptives/Dianette (androgens and progestogens increase sebum production)
- isotretinoin/Roaccutane
- (light based treatments)
Who prescribes isotretinoin?
Skin specialists
Is isotretinoin effective?
•most effective treatment for severe/stubborn acne
What is the prescription regimen for isotretinoin?
Single monotherapy - single daily dose
clearance and 60-70% cure rate
1 mg / kg / day for 16 weeks
What are the drawbacks for isotretinoin?
Highly teratogenic (pregnancy prevention programme)
Many potential side effects
Dry skin (muco - cutaneous junctions)
Hair loss, mood swings, depression, suicide, abnormal LFT’s, hypertriglycerideaemia
Expensive
What does acne rosacea affect?
Central face
What does acne rosacea consist of?
Flushing
Erythema
Papules
Pustules
Telangiectasia
It is unusal to see acne rosacea on non-facial sites
NO COMEDONES
Who does acne rosacea often affect?
Ages 30-50 years
Females more than males
Fair skinned indivisuals
What exacerbates acne rosacea?
Heat
Sunlight
Alcohol
What are the subtypes of acne rosacea?
- erythemato-telangiectatic
- papulo-pustular
- phymatous (M>>>F) - rhinophyma is the soft tissue overgrowth of the nose
- Ocular
What is the TOPICAL treatment of acne rosacea?
- anti-biotics – metronidazole
- azeleic acid
- ivermectin
- brimonidine
What are the non-topical treatments for acne rosacea?
•anti-biotics – tetracyclines
(erythromycin)
(metronidazole)
•isotretinoin
light based treatments
May be worth reading about these
- infantile acne
- acne conglobata
- acne fulminans
- pyoderma faciale/rosacea fulminans
- acne inversa/hidranitis suppurativa
