DERM: Acne

Question 1

Describe the pathogenesis of acne

Answer 1

• Acne results from increased production of sebum, trapping of keratin (dead skin cells) and blockage of the pilosebaceous unit.
• leads to swelling and inflammation in the pilosebaceous unit.

Question 2

what is the pilosebaceous unit and what is its contents?

Answer 2

The pilosebaceous units are the tiny dimples in the skin that contain the hair follicles and sebaceous glands.

Question 3

why is acne exacerbated by puberty and improved with anti-androgenic hormonal contraception?

Answer 3

Androgenic hormones increase the production of sebum

Question 4

what is a comedo/comedones?

Answer 4

SPOTS

• A single lesion is a comedo.
• Open comedones are blackheads; black because of surface pigment (melanin), rather than dirt. Closed comedones are whiteheads; the follicle is completely blocked.

Question 5

which bacteria is thought to exacerbate acne?

Answer 5

The Propionibacterium acnes bacteria is felt to play an important role in acne. This is a bacteria that colonises the skin.

Question 6

what is acne?

Answer 6

Acne is caused by chronic inflammation, with or without localised infection, in pockets within the skin known as the pilosebaceous unit.

Question 7

who does acne commonly affect?

Answer 7

often affecting people during puberty and adolescence

Question 8

what is Seborrhoea with reference to acne?

Answer 8

excessive discharge of sebum from the sebaceous glands.

Question 9

what are Macules with reference to acne?

Answer 9

Macules are flat marks on the skin

Question 10

what are Papules with reference to acne?

Answer 10

Papules are small lumps on the skin

Question 11

what are Pustules with reference to acne?

Answer 11

Pustules are small lumps containing yellow pus

Question 12

what are Ice pick scars with reference to acne?

Answer 12

Ice pick scars are small indentations in the skin that remain after acne lesions heal

Question 13

what are Hypertrophic scars with reference to acne?

Answer 13

Hypertrophic scars are small lumps in the skin that remain after acne lesions heal

Question 14

what are rolling scars with reference to acne?

Answer 14

Rolling scars are irregular wave-like irregularities of the skin that remain after acne lesions heal

Question 15

What is the first line topical treatment for acne?

Answer 15

Topical benzoyl peroxide

• reduces inflammation, helps unblock the skin and is toxic to the P. acnes bacteria

Question 16

with reference to acne, if Topical benzoyl peroxide doesn’t work what are alternative treatments?

Answer 16

• Topical retinoids
• Topical antibiotics
• Oral antibiotics
• Oral contraceptive pill

Question 17

how do topical retinoids act on acne?

Answer 17

(chemicals related to vitamin A) slow the production of sebum

Question 18

how do antibiotics act on acne?

Answer 18

prescribed with benzoyl peroxide to reduce bacterial resistance

Question 19

how does the oral contraceptive pill act on acne?

Answer 19

Oral contraceptive pill can help female patients stabilise their hormones and slow the production of sebum

Question 20

should females use oral retinoids for acne during pregnancy?

Answer 20

It is strongly teratogenic (harmful to the fetus during pregnancy). Patients need to have effective and reliable contraception and must stop isotretinoin for at least a month before becoming pregnant.

Question 21

name a common type of oral retinoid used in severe acne?

Answer 21

Oral isotretinoin (Roaccutane)

Question 22

what are the side effects of Oral isotretinoin (Roaccutane)?

Answer 22

• Dry skin and lips
• Photosensitivity of the skin to sunlight
• Depression, anxiety, aggression and suicidal ideation. Patients should be screened for mental health issues prior to starting treatment.
• Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis