Acneiform eruptions

Question 1

What is Acne vulgaris?

Answer 1

• disease of the pilosebaceous unit (PSU) – face, chest, back
• “sticky” keratinocytes + increased sebum viscosity
• blocked follicles = COMEDONES
• change in commensal bacterial behaviour (Propionibacterium acnes) = INFLAMMATION
• papules, pustules, nodules, cysts, scars

Question 2

What is the epidemiology of Acne vulgaris?

Answer 2

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

Question 3

What are the topical treatments of acne vulgaris?

Answer 3

• retinoids
• benzoyl peroxide (BPO)
• antibiotics
  □ clindamycin
  □ tetracycline
  □ erythromycin
• Others

Question 4

What are the non-topal treatments of acne vulgaris?

Answer 4

• anti-biotics
  □ clindamycin
  □ tetracycline
  □ erythromycin
• anti-androgens : oral contraceptives/Dianette
• isotretinoin/Roaccutane
  □ most effective treatment for severe/stubborn acne
  □ only prescribable by skin specialists
  □ retinoid
  □ simple monotherapy – single daily dose
  □ expect clearance & approx. 60-70% cure rate
  □ 1 mg/kg/day for 16 weeks
  □ Disadvantages
  ® HIGHLY teratogenic (pregnancy prevention programme)
  ® many (potential) side-effects
  ◊ dry skin (mucocutaneous junctions)
  ◊ hair loss, mood swings/depression/suicide, abnormal LFTs, hypertriglyceridemia
  ® expensive
• (light based treatments)

Question 5

What is Acne rosacea?

Answer 5

• chronic inflammation
	○ PSU
	○ cutaneous vasculature
• ace of clubs distribution
• unusual on non-facial sites
• age 30-50 years
• F > M – but M more severe
• fair skinned/Celts
• flushing – alcohol, spices, emotion, hot drinks
• “sensitive” skin
• No Comedones

Question 6

What are the subtypes of acne rosacea?

Answer 6

○ erythematotelangiectatic
○ papulo-pustular
○ phymatous (M>>>F)
○ Ocular 
	- chronically dry, gritty eyes
	- Serious if left alone as one could go blind

Question 7

What are the topical treatments of acne rosacea?

Answer 7

• antibiotics: metronidazole
• azelaic acid (irritating)
• Ivermectin (good for scabies as well)
• Brimonidine

Question 8

What are the non-topical treatments of acne rosacea?

Answer 8

- Antibiotics
	□ Tetracyclines
	□ (Erythromycin) 
	□ (Metronidazole) 
- Isotretinoin
- light based treatments