Acneiform Eruptions

Question 1

Name 2 types of acne.

Answer 1

• Acne vulgaris

- Acne rosacea

Question 2

What is acne vulgaris?

Answer 2

Disease of the pilo-sebaceous unit (PSU) – face, chest, back

Question 3

What causes inflammation in acne vulgaris?

Answer 3

Changes in commensal bacterial behaviour (propionobacterium acnes)

Question 4

What is acne vulgaris characterised by?

Answer 4

• Sticky keratinocytes and increased albumin viscosity
• Comedones
• Papules, pustules, nodules, cysts and scar

Question 5

What is a comedone?

Answer 5

Blocked follicles

Question 6

Give another name for an open comedone.

Answer 6

Blackheads

Question 7

Give another name for a closed comedon.

Answer 7

Whiteheads

Question 8

What topical treatment is there for acne vulgaris?

Answer 8

• Retinoids
• Benzoyl peroxide (PO)
• Anti-biotics
• Other

Question 9

Who is affected by acne vulgaris?

Answer 9

• Peak 15-18 years (90% incidence)
• Delayed onset in some females
• +ve family history
• M=F – but M more severe

Question 10

What topical antibiotics are used in acne vulgaris?

Answer 10

• Clindamycin
• Tetracycline
• Erythromycin

Question 11

What is the non-topical treatment for acne vulgaris?

Answer 11

• Anti-biotics
• Anti-androgens: OCP/Dianette
• Isotrtinoin/Roaccutane
• Light based treatments

Question 12

What non-topical antibiotics can be used in the treatment of acne vulgaris?

Answer 12

• Tetracyclines
• Erythromycin
• Trimethoprim

Question 13

What is the most effective treatment for severe/stubborn acne?

Answer 13

Isotretinoin

Question 14

What is isotretinoin?

Answer 14

Really expensive retinoid that is only prescribable by skin specialists

Question 15

How is isontretinoin administered?

Answer 15

• Simple monotherapy with a single daily dose
• 1mg/kg/day fro 16 weeks
• Better to use 0.5mg/kg/day fro 32 weeks

Question 16

How effective is isotretinoin?

Answer 16

-Expect clearance & approx. 60-70% cure rate

Question 17

What are the drawbacks of isotretinoin?

Answer 17

-HIGHLY teratogenic (pregnancy prevention programme)
-Many (potential) side-effects (dry skin (muco-cutaneous junctions)
hair loss, mood swings/depression/suicide, abnormal LFT’s, hypertriglyceridaemia)
-Expensive

Question 18

What is acne rosacea?

Answer 18

Chronic inflammation involving the PSU and cutaneous vasculature

Question 19

How does acne rosacea present?

Answer 19

-Usually an ace of clubs distribution most commonly on the face

Question 20

Who does acne rosacea affect?

Answer 20

• Age 30-50 years
• F > M – but M more severe
• Fair skinned/Celts

Question 21

What can occur with acne rosacea?

Answer 21

Flushing triggered by

• Alcohol
• Spices
• Emotion
• Hot drinks

Question 22

What are the subtypes of acne rosacea?

Answer 22

• Erythemato
• Telangiectatic
• Papulo-pustular
• Phymatous (M»>F)
• Ocular

Question 23

What is not present in acne rosacea?

Answer 23

Comedones

Question 24

What topical management is there for acne rosacea?

Answer 24

• Anti-biotics – metronidazole
• Azeleic acid
• Ivermectin
• Brimonidine

Question 25

What non-topical management is there for acne rosacea?

Answer 25

• Antibiotics (tetracyclines, erythromycin, metronidazole)-Isotretinoin
• Light based treatment (very useful for the erythemato-telangiectatic sub-type)