Acneiforms Eruptions Flashcards
what is Acne vulgaris?
- disease of the pilo-sebaceous unit (PSU) – face, chest, back
- “sticky” keratinocytes + increased sebum viscosity
- blocked follicles = COMEDONES
- change in commensal bacterial behaviour (Propionobacterium acnes) = INFLAMMATION
- papules, pustules, nodules, cysts, scars
who is acne vulgaris common in?
- Peak 15-18 years (90% incidence)
- delayed onset in some females
- +ve family history
- M=F – but M more severe
- psychological impact
what are the different types of acne?
Comedomal acne
Papulopustular acne
Nodular cystic acne
(form left to right in pictures)
what topical medication can be used for the treatment of acne?
- Benzoyl peroxide (BPO) Acnecide
- Antibiotic: Clindamycin - Dalacin T lotion and Erythromycin – Zyneryt
- Retinoids: Adapalene
- Combination: Duac (BPO and Clindamicin), Treclin (Tretinoin and Clindamicin), Epiduo gel - Adapelene and BPO
- Others - Azaleic acid, Nicatinamide gel
what systemic medication can be used for the treatment of acne?
- antibiotics: tetracyclines, erythromycin, trimethoprim
- anti-androgens: combined oral contraceptive pill
- I sotretinoin (Roaccutane)
- UVB
- Dapsone
what is Isotretinoin?
- 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 neede
what are the risks and saftey procautions needed for Isotretinoin?
- Multiple side effects
- Counselling required prior to treatment
- Teratogenic (pregnancy prevention programme- double method contraception)
- Risk of low mood
- Can raise triglycerides
- many side-effects - Dry skin, lips, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision , myalgia, mood disturbance, skin sensitivity, photosensitivity, headaches
what is Acne Fulminans? what does it cause? what is the treatment?
Sudden onset acneform eruption, feverish and unwell, joint pains
Start low dose Isotretinoin but cover with prednisolone
what are the different types of scarring called?
atrophic
ice pick
hypertrophic
boxcar
keloid
what is the treatment for scarring?
- Treat inflammation first
- I f 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
- PSU
- cutaneous vasculature
- ace of clubs distribution
- unusual on non-facial sites
Rosacea usually causes a persistent redness in the central part of your face. Small blood vessels on your nose and cheeks often swell and become visible. Swollen, red bumps
who si susceptible to acne rosacea?
- age 30-50 years
- F > M – but M more severe
- fair skinned/Celts
- flushing - alcohol, spices, emotion, hot drinks
- “sensitive” skin
what are other subtypes of acne?
- erythemato-telangiectatic
- papulo-pustular
- phymatous (M>>>F)
- Ocular
NO COMEDONES
what is shown here?
Erythemato- telangiectatic
what is shown here?
Papulopustular
what is shown here?
Rhinophyma
What does infantile acne cause and what is the treatment?
- ,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?
Hidradenitis suppurativa (HS), also known as acne inversa, is a long term skin disease characterized by the occurrence of inflamed and swollen lumps. These are typically painful and break open, releasing fluid or pus. The areas most commonly affected are the underarms, under the breasts, and groin
- Recurrent boils and abcesses
- Sinus tract formation
- Axillae, groin and pereneum, submammary
- Follicular occlusion tetrad
- Lifestyle modification
- Topical wash
- Tetracycline
- Topical
- Dapsone
- Adalimumab
- Ciclosporin
