Derm - Acne Vulgaris

Question 1

What is the pathophysiology of acne vulgaris?

Answer 1

Chronic inflammation with/out localised infection in pilosebaceous units

Question 2

What does acne result from?

Answer 2

Increased sebum production trapping keratin and blocking pilosebaceous units

Causing swelling and inflammation in the pilosebaceous units

Question 3

Why is acne exacerbated by puberty?

Answer 3

Androgenic hormones increase sebum production hence exacerbated by puberty

Improves with anti-androgenic hormonal contraception

Question 4

What are swollen inflamed pilosebaceous units called?

Answer 4

Comedones

Question 5

What bacteria can exacerbate acne?

Answer 5

Propionibacterum acnes

Colonises the skin, excessive growth can exacerbate acne

Many treatments aim to reduce this

Question 6

How does acne present?

Answer 6

Red, inflamed and sore spots of skin distributed across face

Can also be on upper chest and upper back

Question 7

What does this show?

Answer 7

Macule

Flat mark on the skin

Question 8

What does this show?

Answer 8

Papule
Small red lumps

Question 9

Answer 9

Pustule
Small lumps containing pus

Question 10

Answer 10

Comedone

Blocked pilosebaceous units which are skin coloured

Question 11

Answer 11

Blackheads
Open comedones with black pigmentation

Question 12

Answer 12

Ice pick scar
Small indentations in the skin that remain after acne lesions heal

Question 13

Answer 13

Hypertrophic scar
Small lumps in skin that remain after acne lesions heal

Question 14

Answer 14

Rolling scar
Irregular wave-like scars that remain after acne lesions heal

Question 15

What is the aim of treatment in acne?

Answer 15

Reduce:
- Symptoms
- Risk of scarring
- Minimise psychosocial impact of condition

Question 16

What must always be explored when treating acne?

Answer 16

Psychosocial burden
Anxiety
Depression

Question 17

What is the stepwise treatment of acne?

Answer 17

1. No treatment acceptable if mild
2. Topic benzoyl peroxide
3. Topic retinoids
4. Topical clindamycin with benzoyl peroxide
5. Oral antibiotics e.g. lymecycline
6. CO-cyprindiol oral contraceptive pill

Last-line
Oral retinoids e.g. isotretinoin

Question 18

How does topical benzoyl peroxide help acne?

Answer 18

Reduces inflammation
Helps unblock skin
Toxic to P.acnes bacteria

Question 19

How do topical retinoids work?

Answer 19

Slow production of sebum

Question 20

Why do oral retinoids need careful follow-up and monitoring?

Answer 20

Highly teratogenic

Question 21

What is oral isotretinoin?

Answer 21

AKA roaccutane

Retin that reduces production of sebum
Reduces inflammation
Reduces bacterial growth

Strongly teratogenic

Patients need to have effective and reliable contraception

Question 22

How long should oral isotretinoin be stopped before becoming pregnant?

Answer 22

1 month

Question 23

What are the side effects of isotretinoin?

Answer 23

Dry skin and lips
Photosensitivity of skin to sunlight
Depression, anxiety, aggression and suicidal ideation
Rarely Stevens-Johnson syndrome and toxic epidermal necrolysis