Derm - Acne Vulgaris Flashcards
What is the pathophysiology of acne vulgaris?
Chronic inflammation with/out localised infection in pilosebaceous units
What does acne result from?
Increased sebum production trapping keratin and blocking pilosebaceous units
Causing swelling and inflammation in the pilosebaceous units
Why is acne exacerbated by puberty?
Androgenic hormones increase sebum production hence exacerbated by puberty
Improves with anti-androgenic hormonal contraception
What are swollen inflamed pilosebaceous units called?
Comedones
What bacteria can exacerbate acne?
Propionibacterum acnes
Colonises the skin, excessive growth can exacerbate acne
Many treatments aim to reduce this
How does acne present?
Red, inflamed and sore spots of skin distributed across face
Can also be on upper chest and upper back
What does this show?
Macule
Flat mark on the skin
What does this show?
Papule
Small red lumps
Pustule
Small lumps containing pus
Comedone
Blocked pilosebaceous units which are skin coloured
Blackheads
Open comedones with black pigmentation
Ice pick scar
Small indentations in the skin that remain after acne lesions heal
Hypertrophic scar
Small lumps in skin that remain after acne lesions heal
Rolling scar
Irregular wave-like scars that remain after acne lesions heal
What is the aim of treatment in acne?
Reduce:
- Symptoms
- Risk of scarring
- Minimise psychosocial impact of condition
What must always be explored when treating acne?
Psychosocial burden
Anxiety
Depression
What is the stepwise treatment of acne?
- No treatment acceptable if mild
- Topic benzoyl peroxide
- Topic retinoids
- Topical clindamycin with benzoyl peroxide
- Oral antibiotics e.g. lymecycline
- CO-cyprindiol oral contraceptive pill
Last-line
Oral retinoids e.g. isotretinoin
How does topical benzoyl peroxide help acne?
Reduces inflammation
Helps unblock skin
Toxic to P.acnes bacteria
How do topical retinoids work?
Slow production of sebum
Why do oral retinoids need careful follow-up and monitoring?
Highly teratogenic
What is oral isotretinoin?
AKA roaccutane
Retin that reduces production of sebum
Reduces inflammation
Reduces bacterial growth
Strongly teratogenic
Patients need to have effective and reliable contraception
How long should oral isotretinoin be stopped before becoming pregnant?
1 month
What are the side effects of isotretinoin?
Dry skin and lips
Photosensitivity of skin to sunlight
Depression, anxiety, aggression and suicidal ideation
Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis
