Acnneiform eruptions

Question 1

What is acne vulgaris?

Answer 1

Disease of the pilo-sebaceous unit (PSU) – face, chest, back

“sticky” keratinocytes + increased sebum viscosity

Question 2

What are comodones?

Answer 2

Blocked follicles

Question 3

Why does inflammation occur in acne vulgaris?

Answer 3

Change in commensal bacterial behaviour

Propionobacterium acnes

Question 4

What is the aetiology of acne vulgaris?

Answer 4

Peak 15-18 years (90% incidence)
Delayed onset in some females
\+ve family history
M=F – but M more severe
Psychological impact

Question 5

What are the different types of acne vulgaris?

Answer 5

Comedomal acne
Papulopustular acne
Nodular cystic acne

Question 6

What is acne fulminans?

Answer 6

Sudden onset acneform eruption, feverish and unwell, joint pain

Question 7

What is the treatment of acne fulminans?

Answer 7

Start low dose isotertinoin but cover with prednisolone

Question 8

What are the different topical medication treatments for acne?

Answer 8

Benzoyl peroxide
Antibiotic
Retinoids
Combination medication
Other treatments

Question 9

What is benzoyl peroxide?

Answer 9

Acnecide

Question 10

What is the different antibiotics for acne?

Answer 10

Clindamycin- Dalacin T lotion

Erythromycin- Zyneryt

Question 11

What is the retinoid example?

Answer 11

Adapalene

Question 12

What is the combination treatment for acne?

Answer 12

Duac ( BPO and Clindamicin)

Treclin (Tretinoin and Clindamicin)

Epiduo gel – Adapelene and BPO

Question 13

What are the other treatments of acne?

Answer 13

Azaleic acid

Nicatinamide gel

Question 14

What are the different systemic medications for acne?

Answer 14

Antibiotics- Tetracyclines, erythromycin and trimethoprim
Anti-adrogens- Combined oral contraceptive pill
Isotertinoin
UVB
Dapsone

Question 15

What is isotertinoin?

Answer 15

Retinoid medication - vitamin A derivative

Most effective treatment

Reserved for treatment failure, evidence of scarring, severe acne, acne fuminans

Weight based treatment- aim to achieve total cumulative dose 120mg/kg

60-70% clear and remain clear

Can have multiple treatment courses if needed

Multiple side effects

Counselling required prior to treatment

Teratogenic (pregnancy prevention programme- double method contraception)

Risk of low mood

Can raise triglycerides

Question 16

What is isotretinoin’s side effects?

Answer 16

Dry skin, lips, epistaxis, dry brittle hair, nail dystrophy, reduction in night time vision , myalgia, mood disturbance, skin sensitivity, photosensitivity, headaches

Question 17

What is the treatment for scarring?

Answer 17

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- Punch biopsy
Laser
Dermabraison
Chemical peels

Question 18

What does acne rosacea look like?

Answer 18

chronic inflammation
ace of clubs distribution
unusual on non-facial sites

Question 19

What is the aetiology of acne rosacea look like?

Answer 19

age 30-50 years
F > M – but M more severe
fair skinned/Celts
flushing – alcohol, spices, emotion, hot drinks
“sensitive” skin

Question 20

What is the topical treatment of acne rosacea?

Answer 20

Metronidazole- Rosex, Metrogel

Azeleic acid- Finacea

Ivermectin- Soolantra

Brimonidine- Mirvaso

Question 21

What is the systemic treatment of acne rosacea?

Answer 21

Oral antibiotics – tetracyclines and erythromycin

Isotretinoin- low dose

Light based treatments

Laser

Question 22

What is infantile acne?

Answer 22

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

Question 23

What is acne keloidalis nuchae?

Answer 23

Most common in skin type V and VI

Chronic folliculitis and scarring hair loss

Inflammation and secondary bacterial infecition
Topical steroids
Antimicrobial wash
Oral antibiotics
Laser hair removal

Question 24

What is hidradenitis suppuriitiva?

Answer 24

Recurrent boils and abcesses

Sinus tract formation

Found usually in axillae, groin and pereneum, submammary

Question 25

What is the treatment of hidradenitis suppuritiva?

Answer 25

Lifestyle modification
Topical wash
Tetracycline 
Topical 
Dapsone
Adalimumab
Ciclosporin

Question 26

What is follicular occlusion tetrad?

Answer 26

Refers to a group of diseases in which hair follicles become blocked with keratin (scale) and then rupture, resulting in inflammatory skin disease.

These conditions commonly coexist. They may be severe and difficult to treat.