Acnneiform eruptions Flashcards
What is acne vulgaris?
Disease of the pilo-sebaceous unit (PSU) – face, chest, back
“sticky” keratinocytes + increased sebum viscosity
What are comodones?
Blocked follicles
Why does inflammation occur in acne vulgaris?
Change in commensal bacterial behaviour
Propionobacterium acnes
What is the aetiology of acne vulgaris?
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 vulgaris?
Comedomal acne
Papulopustular acne
Nodular cystic acne
What is acne fulminans?
Sudden onset acneform eruption, feverish and unwell, joint pain
What is the treatment of acne fulminans?
Start low dose isotertinoin but cover with prednisolone
What are the different topical medication treatments for acne?
Benzoyl peroxide Antibiotic Retinoids Combination medication Other treatments
What is benzoyl peroxide?
Acnecide
What is the different antibiotics for acne?
Clindamycin- Dalacin T lotion
Erythromycin- Zyneryt
What is the retinoid example?
Adapalene
What is the combination treatment for acne?
Duac ( BPO and Clindamicin)
Treclin (Tretinoin and Clindamicin)
Epiduo gel – Adapelene and BPO
What are the other treatments of acne?
Azaleic acid
Nicatinamide gel
What are the different systemic medications for acne?
Antibiotics- Tetracyclines, erythromycin and trimethoprim
Anti-adrogens- Combined oral contraceptive pill
Isotertinoin
UVB
Dapsone
What is isotertinoin?
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
What is isotretinoin’s 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 the 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- Punch biopsy Laser Dermabraison Chemical peels
What does acne rosacea look like?
chronic inflammation
ace of clubs distribution
unusual on non-facial sites
What is the aetiology of acne rosacea look like?
age 30-50 years F > M – but M more severe fair skinned/Celts flushing – alcohol, spices, emotion, hot drinks “sensitive” skin
What is the topical treatment of acne rosacea?
Metronidazole- Rosex, Metrogel
Azeleic acid- Finacea
Ivermectin- Soolantra
Brimonidine- Mirvaso
What is the systemic treatment of acne rosacea?
Oral antibiotics – tetracyclines and erythromycin
Isotretinoin- low dose
Light based treatments
Laser
What is 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 acne keloidalis nuchae?
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
What is hidradenitis suppuriitiva?
Recurrent boils and abcesses
Sinus tract formation
Found usually in axillae, groin and pereneum, submammary
What is the treatment of hidradenitis suppuritiva?
Lifestyle modification Topical wash Tetracycline Topical Dapsone Adalimumab Ciclosporin
What is follicular occlusion tetrad?
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.
