Acneiform Eruptions: ance vulgaris and acne rosacea

Question 1

What happens in Acne vulgaris?

Answer 1

Sticky keratinocytes and increased sebum viscosity, causing blocked sebaceous glands in follicle, called comedones, leads to inflammation.

Question 2

Comedonal acne treatment
Papulopustular acne
Nodular cyctic acne
Acne Fulminans

Answer 2

Comedonal acne treatment - more with retinoids (antibiotics not as effective)

Papulopustular acne (like the classic, Angus (sorry buddy)

Nodular cyctic acne (inc. nodules)

Acne Fulminans (much more sever, including on chest. WIll present as systemically unwell, appears suddenly, joint pain. Isotrenoin makes worse initially so have to stabilise with prednisolone

Question 3

Treatment of acne

Answer 3

1. usually Benzoyl peroxide (Acnecide) cream
2. Antibiotic cream - Clindamycin (Dalacin T Lotion, mainly used in children), or erythromycin (Zyneryt)
3. Retinoids (Isotretinoin or Adapalene)

Can use combination ones too eg Duac, Treclin or Epiduo gel

Question 4

Aim tratment level for isotretinoin. When reserved for?

Answer 4

If other topical treatments/ antibiotics haven’t been working. In girls requires them to come in for regular pregnancy tests.

Question 5

How does Isotretinoin work?

Answer 5

Effectivly by drying out skin and mucous membranes. So the skin can become thinner and more sensitive to things.

Question 6

Does Isotretinoin interact with tetracyclines?

Answer 6

YES. So don’t give at the same time.

Question 7

What is Acne Rosacea?

Answer 7

red inflammation disease of the skin that mainly effects women. Is more across the forhed, nose, cheeks.

Question 8

What are the sub types of acne Rosacea?

Answer 8

erythemato-telangiectatic (really red in places, looks like a tele-signal (think red telivisionantena)

papulo-pustular - red and more acne like in the right places

phymatous (M»>F)

Ocular (to do with the eye)

Question 9

What is Rhinophyma?

Answer 9

Issue with the nose, and ears, rudolf like , swelling due to the blocked sebaceous glands inflammation

Question 10

AR treatment

Answer 10

Metronidazole- Rosex, Metrogel
Azeleic acid- Finacea
Ivermectin- Soolantra
Brimonidine- Mirvaso

Question 11

Acne Keloidlis nuchae?

Answer 11

Back of head, skin types V and Vi, just below hair line, more common in the shorter hairs, chronic folliculitis and scarring. Inflammation secondary to the bacterial inflammation.

Question 12

Hidradenitis suppuritiva?

Answer 12

Adalimumab often used to kick start the treatment. Like massive creases in armpits, groin, submammary, pereneum (sinus tract formation) due to recurrent boils and abcesses .