Acneiform Eruptions Flashcards
Two types of acne
Acne Vulgaris
Acne Rosacea
What is acne vulgaris?
Disease of the pilo-sebaceous unit (PSU)
Where does acne vulgaris effect?
Face
Chest
Back
Pathology of acne vulgaris
“Sticky” keratinocytes + increased sebum viscosity
Formation of keratin plug causing obstruction of pilosebacous follicle
Blocked follicles called comedones
Changes in commensal bacterial behaviour (Propionibacterium acnes) = inflammation
Presentation of acne vulgaris
Papules Pustules Nodules Cysts Scars 1. Comedones (due to dilated sebaceous follicle) - top closed = whitehead - top open = blackhead 2. Inflammatory lesions form when follicle bursts releasing irritants - papules, pustules 3. Excessive inflammatory response may result in nodules or cysts 4. Can cause scarring - ice pick scars - hypertrophic scars
Peak age to get acne vulgaris
15 - 18 years old (90% incidence)
Which gender may have delayed onset of acne vulgaris?
Females
Which gender gets acne vulgaris?
M = F
But males more severe
Does acne run in families?
Yes
What is acne roasacea?
Chronic inflammation of
- PSU
- Cutaneous vasculature
Distribution of acne roasacea
Ace of clubs distribution
Nose, cheeks and forehead
What age gets acne roasacea?
30 - 50 y/o
Which gender gets acne roasaecea?
F > M
But male more severe
Who gets acne rosaecea?
Fair skinned / celts
Presentation of acne rosaecea
Flushing - alcohol - spices - emotion - hot drinks "Sensitive Skin"
Subtypes of acne rosacea
Erythemato-telangiectatic
Papulo-pustular
Phymatous (M»>F)
Ocular
Do you get comedones in acne rosacea?
NO
Do you get comedones in acne vulgaris?
Yes
What are comedones?
Skin coloured small bumps (papules) frequently found on the forehead and chin on those with acne
A single lesion is a comedo
What are open comedones?
Blackheads
What are closed comedones?
Whiteheads as the follicle is completely blocked
In blackheads, what causes the black colour?
Surface pigment (melanin)
Treatment of acne vulgaris
Topical - retinoids - benzoyl peroxide (BPO) - Antibiotics (clindamycin, tetracycline, erythromycin) Antibiotics - tetracyclines - erythromycin Anti-androgens - oral contraceptives - dianette Isotretinoin/roaccutane
What is the most effective treatment for severe/stubborn acne?
Isotretinoin
What type of drug is isotretinoin?
Retinoid
What is the cure rate for isotretinoin?
60-70%
Side effects of isotretinoin
HIGHLY teratogenic Dry skin (muco-cutaneous junction) Hair loss Mood swings/depression/suicide Abnormal LFTs Hypertriglyceridemia
Treatment for acne rosacea
Topical - antibiotics (metronidazole) - azelaic acid - ivermectin - brimonidine Antibiotics - tetracyclines Isotretinoin Light based treatments Daily application of high factor suncream Laser - if prominent telangiectasia
Can acne roasacea be cured?
No
Presentation of acne roseacea
Flushing (often 1st symptom) Telangiectasia Later - persistent erythema with papules and pustules Ocular involvement - blepharitis Rhinophyma
What is rhinophyma?
Development of a large, bulbous nose associated with granulomatous infiltration, commonly due to untreated rosacea
Adverse effects of isotretinoin
Teratogenicity (2 forms of contraception)
Dry skin, lips, eyes and mouth
Low mood
Raised triglycerides
Hair thinning
Nose bleeds (due to dryness of nasal mucosa)
Intracranial HTN (not to be used with tetracyclines)
Photosensitivity
What is the most common side effect of isotretinoin?
Dry skin, eyes and lips/mouth
First line treatment of moderate - severe acne rosacea
Oxytetracycline
Treatment of mild acne rosacea
Topical metronidazole
What is the bacteria known to contribute to the development of acne?
Propionibacterium acnes
