December 2, 2015 - Acne

Question 1

Acne Vulgaris

Answer 1

Inflammatory papules, pustiles, nodules, cysts and comedones.

Most common diagnosis in dermatology.

All acne can scar, and treatment is offered to prevent further scarring, as well as to prevent psychological damage.

Question 2

Propionibacterium acnes

Answer 2

A slow-growing, typically aerotolerant anaerobic, Gram-positive bacilli.

Can cause acne vulgaris and folliculitis.

Question 3

Etiology of Acne Vulgaris

Answer 3

Increasing effects of hormones in puberty targets the follicular sebaceous unit

Hyper-keratinization of the follicular infundibulum (develop blackhead)

Increased in sebum production (blocks follicles)

Overgrowth of P. acnes

Question 4

Acne Classification

Answer 4

Comedonal (least severe)

Pustular

Papular

Nodular

Cystic (most severe)

Question 5

Isotretinoin

Answer 5

Accutane

Is very effective for dealing with acne. Exerts strong effects on sebum excretion, keratinisation, follicular P. acnes, and inflammation.

But, requires bloodwork monitoring, is a teratogen, may cause mood changes, may cause a rash, and you cannot be on it indefinitely. Only prescribe if you are familiar with the drug.

Expect a 50% improvement at 6 weeks, and a maximal effect at 12 weeks.

Question 6

Rosacea

Answer 6

Is a skin condition characterized by facial redness, small and superficial dilated blood vessels, papules, pustules, and swelling.

Begins with flushing/blushing, then red complexion and telangiectasia worsen, next inflammatory papules and pustules develop.

This is chronic and lifelong, but usually well-controlled with treatment.

Question 7

Rosacea - Treatment

Answer 7

Topical antibiotics including metronidazole, clindamycin, erythromycin, and sulfacetamide.

Oral antibiotics.

Oral retinoids.

Question 8

Perioral Dermatitis

Answer 8

A skin disease characterised by multiple small papules, pustules and vessicles that are localized to the perioral skin (around the mouth), perinasal or nasolabial folds.

Commonly affects women aged 15-40.

Often spares the area of the upper lip. Ocular involvement (skin around eyes) is a clue that it is perioral dermatitis.

Resist prescribing corticosteroids. It will cause it to worsen.

Treat with same protocols as rosacea. Antibiotics (topical and systemic as well as retinoids)

Question 9

Perioral Dermatitis - Treatment

Answer 9

Treat with same protocols as rosacea. Antibiotics (topical and systemic)

Also consider retinoids.