Dermatology B presentations Flashcards
Information for patients with acne vulgaris - the condition
- Very common in teens
- Chronic inflammatory condition - mainly face, back and chest
- Blockage and inflammation of pilosebaceous unit
- These usually lubricate the skin and hair to stop it drying out by producing sebum
- In acne, too much sebum = plugged follicle
- Sometimes bacteria that usually lives on skin can contaminate and infect the plugged follicles
Causes of acne/links
- Increased levels of testosterone during puberty
- Runs in families
- Women - hormonal changes during menstrual cycle, pregnancy or PCOS can lead to acne
- Medications - steroids, lithium, epilepsy meds
- Smoking
Misconceptions about acne
- Caused by dirty skin - no, it’s what happens beneath the skin
- It’s infectious - it is not
- Squeezing can make them go away - can lead to infections and scarring
- Sunbeds/sunbathing helps - no, treatments for acne can make skin more sensitive to the light so can increase risk of skin cancer
- Toothpaste can dry it up - can irritate and damage skin
Treatment options - mild/moderate acne
12 week course of:
* Topical adapalene (retinoid) + benzoyl peroxide
* Topical tretinoin (retinoid) with topical clindamycin
* Topical benzoyl peroxide with topical clindamycin
Treatmetn for moderate to severe acne
12 week course of:
* First two options for mild/moderate acne
* Topical adapalene with topical benzoyl peroxide with oral lymecycline/doxycycline OD
* Topical azelaic acid with oral lymecycline/doxycycline
* COCP can also be used in combo with topical agents as an alternative to oral abx
Trimethoprim/oral macrolide can be used for those who cannot tolerate/contraindications to lymecycline/doxycycline
When to refer to dermatology acne?
- Mild to moderate acne that has not responded to 2 completed courses of treatment
- Moderate to severe acne that has not responded to previous treatment that includes oral abx
- Acne with scarring/persistent pigmented changes
- Causing/contributing persistent psychological distress
When to urgently refer acne?
Acne fulminans - same day to on-call hospital derm team, need to be assessed within 24hrs
Classification of acne
- Mild - non-inflamed lesions predominantly (open and closed comedones) with few inflammatory lesions
- Moderate - more widespread with increased no. of inflammatory papules and pustules
- Severe - widespread inflammatory papules, putules and nodules/cysts, scarring may be present
3 types of acne
- Non-inflammatory - comedones which can be open (blackheads) or closed (whiteheads) or microcomedones (clinically invisible)
- Inflammatory - papules and pustules, in more severe can be deeper pustules, nodules or cysts
- Mix
Does acne resolve?
- People typically have several years of it
- Symptoms improve as get older
- Resolving by mid 20s
- Some cases can continue into adult life
General advice for acne treatment
- Avoid over-cleaning skin
- Non-alkaline synthetic detergent cleansing product twice daily
- Avoid oil based comedogenic skin products
- Remove make up at end of day
- Picking/scratching can lead to scarring
- Treatments may take 6-8 weeks before seeing benefit may irritate the skin at start of treatment
- Maintain healthy diet
Follow up for acne
- Review first line after 12 weeks to assess for improvement/adverse efefcts
- If prescribed oral abx, if resolved consider stopping and continuing with topical. If not consider continuing.
- Always review every 3 months
- Do not prescribe oral abx for more than 6 months
If acne has cleared in 12 weeks
- May not need maintence therapy
- But if history of relapse consider topical adapalene and benzoyl peroxide
- Review again at 12 weeks
If acne has not cleared at 12 weeks
- Offer alterantive treatment in mild/moderate
- If fails after another 12 weeks consider referral to derm
- If moderate/severe offer oral abx or consider referring
Safety netting acne
- Acne fulminans - severe inflammatory acne
- Trunk esp
- Feel unwell with fever, joint pain and lethargy
- Attend a&e or ring GP for urgent same day derm review
- Advice on if allergic reaction to treatment stop this and return. Some irritation is expected.
- If anaphylaxis –> a&E
