Acneiform lesions: Acne vulgaris, Rosacea, Folliculitis

Question 1

Define/causes of acne vulgaris?

Answer 1

Chronic skin disorder affecting the pilo-sebaceous unit, resulting in blockage of the follicle, formation of comedones and inflammation.

Prevalence is highest in adolescents and young adults.

Question 2

Presentation of acne vulgaris?

Answer 2

Macules, papules, pustules, cysts, and comedones may be present.

Scarring
- hypertrophic (raised scars) and keloid scars are common in darker skin tones
- atrophic (flat or indented scars)

Hyperpigmentation and hypopigmentation, erythema - post-inflammatory acne

Acne fulminans, acne conglobata (uncommon but severe)

Nodules and cysts can be ulcerating and have haemorrhagic appearance.

Question 3

Diagnosis of acne vulgaris?

Answer 3

Clinical diagnosis

May do a swab if diagnosis is uncertain.

Question 3

RFs of acne vulgaris?

Answer 3

Hormonal changes
Increased sebum (oil) production.
Blockage of hair follicles and sebaceous glands by keratin and sebum.
Bacterial colonization
FHx of acne
Medications (e.g. corticosteroids, hormonal tx)

Question 4

Management of acne vulgaris?

Answer 4

All are 12wk course tx. Combining drugs = reduces antimicrobial resistance.

Mild/moderate acne (any of the two):
- Topical benzoyl peroxide.
- Topical antibiotics (clindamycin)
- Topical retinoids (tretinoin/adapalene)

Moderate-severe acne (one of the following):
1ST LINE
- Topical retinoids (tretinoin/adapelene) + topical benzoyl peroxide
- Topical retinoids + topical antibiotics (clindamycin)
- Topical benzoyl peroxide + topical retinoid (tretinoin/adapelene) + oral antibiotic (lymecycline/doxycycline.)

2ND LINE
- oral abx (trimethoprim and erythromycin)
- COCP

(topical retinoids and oral tetracyclines are contraindicated during pregnancy)

Question 5

How is acne vulgaris classified?

Answer 5

Non-inflammatory: blackheads and whiteheads.

Inflammatory: inflammatory papules, pustules, and nodules (cysts.)

Mild acne: predominantly non-inflammatory lesions.

Moderate acne: predominantly inflammatory papules and pustules.

Severe acne: nodules (cysts), scarring, acne fulminans, and acne conglobata.

Question 6

Define/causes/diagnosis of rosacea?

Answer 6

Skin condition characterised by episodic or persistent facial flushing.

Women aged between 30 to 60 who have fair skin.

Diagnosis

Question 7

Presentation of rosacea?

Answer 7

Facial flushing -exacerbated by alcohol, heat, sun exposure, warm baths, stress, spicy food, and irritating cosmetic products.

Telangiectasia may develop over time, and redness becomes more persistent.

Papules, pustules

Rhinophymatous rosacea (men)

Ocular rosacea

Burning and tingling sensation

Symmetrical localisation on cheeks, nose, or neck.

Question 8

Management of rosacea?

Answer 8

Avoid triggers -alcohol, sun protection.

Reduce flushing:
- Topical brimonidine or oral propranolol.

For telangiectasia:
- Laser therapy.

For papulopustular variants:
- Metronidazole topical (1ST LINE)
- Oral tetracycline (2ND LINE)

Question 9

Define/causes of folliculitis?

Answer 9

Aka pimples.

Inflammation of a hair follicle that results in the formation of papules or pustules.

Bacterial infections
- Staphylococcus aureus

Question 10

Presentation of folliculitis?

Answer 10

papules and pustules
looks red
- anywhere on the body EXCEPT palms of hands and soles of feet.

Question 11

Diagnosis/IVx of folliculitis?

Answer 11

Clinical diagnosis

Skin biopsy (in cases of eosinophilic folliculitis)

Question 12

Management of folliculitis?

Answer 12

topical abx + antibacterial soaps (chlorhexidine)

oral abx (flucloaxicillin)