Acneiform eruptions Flashcards
What is Acne vulgaris
Common disease of the pilo-sebaceous unit (PSU) – face, chest, back
“sticky” keratinocytes + increased sebum viscosity
blocked follicles = Comedones
Includes papules, pustules, nodules, cysts and scars
What causes inflammation in acne?
Change in commensal bacterial behaviour (Propionobacterium acnes)
What is a closed comedone more commonly called
A whitehead
What is an open comedone more commonly called
Blackhead
What is a pilo-sebaceous unit?
hair follicles and their accompanying sebaceous gland
Who does Acne vulgaris affect?
Peak 15-18 years (90% incidence)
Delayed onset in some females
+ve family history
M=F – but M more severe
psychological impact
Different types of acne
Nodular cystic acne Papulopustular acne Comedomal acne Acne rosacea Infantile acne Hidradenitis suppuritiva
Which Topical Treatments are available for acne
Benzoyl peroxide (BPO)
Antibiotic - clindamycin, dalacin T lotion, Erythromycin
Retinoids - adapalene
Combination therapies
Others - Azaleic acid, Nicatinamide gel
Systemic medication for acne
Antibiotics - tetracyclines, erythromycin, trimethoprim
anti-androgens : combined oral contraceptive pill
Isotretinoin (Roaccutane)
Used in combination:
UVB
Dapsone
Isotretinoin/Roacutane
Retinoid medication - vitamin A derivative
Most effective treatment
Reserved for treatment failure, evidence of scarring, severe acne, acne fuminans
Prescribed by Dermatologists and dispensed by hospital pharmacy
Weight based treatment- aim to achieve total cumulative dose 120mg/kg
60-70% clear and remain clear
Can have multiple treatment courses if needed
Side effects of isotretinoin/roacutane
Dry skin, lips, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision , myalgia, mood disturbance, skin sensitivity, photosensitivity, headaches
Important things that need to be addressed before starting roacutane
Counselling required prior to treatment
Teratogenic (pregnancy prevention programme- double method contraception)
Risk of low mood
Many side-effects
Acne Fulminans
Sudden onset acneform eruption, feverish and unwell, joint pains
Start low dose
Isotretinoin but cover with prednisolone
Name some different types of acne scars
Boxcar Atrophic Ice pick Keloid Hypertrophic
Treatment for scarring
Treat inflammation first
If had Isotretinoin usually should wait for 1 year before looking into treatment for scarring
Treatment depends on type of scarring: Intralesional steroid Excision of ice pick scars Laser Dermabraison Chemical peels
What is Acne rosacea
Chronic inflammation
affects pilo-sebaceous unit
Cutaneous vasculature damage
Ace of clubs distribution, red
Usually on the face
Who does acne rosacea affect?
age 30-50 years
F > M – but M more severe
fair skinned/Celts
flushing – alcohol, spices, emotion, hot drinks
“sensitive” skin
Sub-types of Acne rosacea
Erythemato-telangiectatic - flushing, persistent central facial erythema + telangiectasias (red lines from dilated vessels)
papulo-pustular - bumps and pustules
phymatous (M»>F) - nose increases in size, thickens and looks bumpy
Ocular - eyes/eyelids
no comedones
Topical Treatment of Acne Rosacea (4)
Metronidazole- Rosex, Metrogel
Azeleic acid- Finacea
Ivermectin- Soolantra
Brimonidine- Mirvaso
Systemic Treatment of Acne Rosacea (4)
Oral antibiotics - tetracyclines, erythromycin
Isotretinoin - low dose
Light based treatments
Laser
Infantile acne
3months- 1year
Comedome, papules, pustules and cysts
Same treatment in adults
Need to treat to prevent scarring
If greater than 1 year look for signs of virilization
What is Hidradenitis suppuritiva/acne inversa?
Recurrent boils and abcesses - typically painful and break open, releasing fluid or pus.
Tend to form in Axillae, groin and pereneum, submammary
Part of the follicular occlusion triad - 3 conditions that usually coexist
Look
Comedonal acne - closed and open
Inflammatory acne - pustules and papules
Nodulocystic acne - cysts and nodules
