Acneiform Eruptions Flashcards
What is acne vulgaris?
Disease of the pilo-sebaceous unit (PUS) - face, chest and back
Sticky keratinocytes and increased sebum viscosity
Blocked follicles - comedones
Inflammation - change in commensal bacterial behaviour
What is the appearance of acne vulgaris?
Papules, pustules, nodules, cysts and scars
What blocks the follicle in acne vulgaris?
Sebum in sebaceous gland with follicle
What is a whitehead and a blackhead?
Closed comedo - whitehead
Open comedo - blackhead
Blockage causes inflammation
Who does acne vulgaris affect?
Peaks at 15-18years
Delayed onset in females
Positive family history
Male=Females but males more severe
Psychological impact
What is comedomal acne?
Skin coloured bumps and blackheads scattered
Increased sebum production
Blockage of sebaceous duct and follicle and inflammation caused
What are some types of acne vulgaris?
Comedomal acne, nodular cystic, acne fulminans acne and papulo-pustular acne
What is the topical treatment for acne vulgaris?
Benzoyl peroxide (BPO) - acnecide
Antibiotics - Clindamycin (Dalacin T lotion) and Erythromycin (Zyneryt)
Retinoids - Adapalene
Combination
Others - Azaleic acid and Nicatinamide gel
What are the combination topical treatments for acne vulgaris?
Duac - BPO and Clindamycin
Treclin - Tretinoin and Clindamycin
Epiduo - Adapalene and BPO
What are some systemic medications for acne vulgaris?
Antibiotics - Tetracyclines, erythromycin and trimethoprim
Anti-androgens - combined oral contraception pill
Isotretinoin
UVB
Dapsone
What is isotretinoin?
Retinoid medication - vitamin A derivative
Most effective treatment but reserved for treatment failure, severe acne, acne fulminans and evidence of scarring
How is isotretinoin prescribed?
By dermatologists and dispensed by hospital pharmacy
Weight based treatment - 120mg/kg
60-70% clear and remain clear
Can have multiple treatment courses if needed
What are the risks of isotretinoin?
Teratogenic
Risk of low mood
Can raise triglycerides
Dry skin, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision, myalgia, skin sensitivity, photosensitivity and headaches
Describe acne fulminans
Sudden onset acneiform eruption
Feverish and unwell
Joint pains
Start low dose isotretinoin but cover with prednisolone
What are the types of scarring?
Atrophic, Boxcar (linear indentation), ice pick ( more prominent indentation), keloid and hypertrophic
What is the treatment for scarring?
Treat inflammation first
If isotretinoin then wait 1 year before looking for treatment for scarring - intralesional steroid, laser, excision of ice pick scars, dermabrasion and chemical peels
Describe acne rosacea
Chronic inflammation which effects PSU and cutaneous vasculature
Ace of clubs distribution
Unusual on non-facial sites
No comedomes
Who is acne rosacea likely to affect?
Age 30-50 years
More females then males but males more severe
Flushing - alcohol, spices, emotion and hot drinks
Sensitive skin
What are the subtypes of acne rosacea?
Erythemato-telangiectatic
Papulo-pustular
Phymatous (more males)
Ocular
What is the topical treatment for acne rosacea?
Metronidazole - Rosex and Metrogel
Azeleic acid - Finacea
Ivermectin - Soolantra
Brimonidine - Mirvaso
What is the systemic treatment for acne rosacea?
Oral antibiotics - tetracyclines and erythromycin
Isotretinoin - low dose
Light based treatments
Laser
Describe infantile acne
3months - 1 year
Comedomes, papules, pustules and cysts
Same treatment as adults - need to prevent scarring
If greater than 1 year look for signs of virilization
Describe Hidradenitis suppuritiva
Recurrent boils and abscesses
Sinus tract formation
Axillae, groin and perineum and sub-mammary
Flexural site
Follicular occlusion tetrad
What is the treatment for Hidradenitis suppuritiva?
Lifestyle modification, topical wash, tetracycline, topical, dapsone, adalimumab and ciclosporin
Describe acne keloidalis nuchae
Most common skin type V and VI
Chronic folliculitis, scarring and hair loss
Inflammation and secondary bacterial infection
What is the treatment for acne keloidalis nuchae?
Topical steroid, antimicrobial wash, oral antibiotics, isotretinoin and laser hair removal
